Provider Demographics
NPI:1225425242
Name:MCMAHON, MARK ALLEN (LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 N FRONT ST
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37130-2829
Mailing Address - Country:US
Mailing Address - Phone:615-589-5076
Mailing Address - Fax:
Practice Address - Street 1:416 N FRONT ST
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2829
Practice Address - Country:US
Practice Address - Phone:615-589-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000010135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist