Provider Demographics
NPI:1609001916
Name:MAHON, FREDERICK (PT)
Entity Type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:
Last Name:MAHON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E 14TH ST
Mailing Address - Street 2:SUITE 336
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4103
Mailing Address - Country:US
Mailing Address - Phone:347-432-3131
Mailing Address - Fax:
Practice Address - Street 1:111 E 14TH ST
Practice Address - Street 2:SUITE 336
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4103
Practice Address - Country:US
Practice Address - Phone:347-432-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-16
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021973225100000X
PAPT014272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist