Provider Demographics
NPI:1518612100
Name:MAHAN, EMILY CHRISTINE (MS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CHRISTINE
Last Name:MAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 W ALLEN ST APT 11
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3028
Mailing Address - Country:US
Mailing Address - Phone:812-380-1749
Mailing Address - Fax:
Practice Address - Street 1:107 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405-7000
Practice Address - Country:US
Practice Address - Phone:812-855-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-13
Last Update Date:2022-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer