Provider Demographics
NPI:1427012640
Name:MAHONEY, JOANNE M (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 INDIAN RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085
Mailing Address - Country:US
Mailing Address - Phone:781-258-1461
Mailing Address - Fax:
Practice Address - Street 1:19 INDIAN RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:781-258-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB501027OtherCIGNA
MA0014454OtherNEIGHBORHOOD HEALTH PLAN
MA0314692Medicaid
MAY66628OtherBLUE CROSS
MA908025OtherTUFTS HEALTH PLAN
MAB321OtherHARVARD PILGRIM
MAB501027OtherCIGNA