Provider Demographics
NPI:1477684348
Name:MCMAHON, KENNETH PHILLIP (DPT)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PHILLIP
Last Name:MCMAHON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 SAGE FIELD DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:TN
Mailing Address - Zip Code:38002-1506
Mailing Address - Country:US
Mailing Address - Phone:901-486-9064
Mailing Address - Fax:
Practice Address - Street 1:10992 HIGHWAY 51 S STE 100
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:TN
Practice Address - Zip Code:38004-4945
Practice Address - Country:US
Practice Address - Phone:901-486-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6204225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist