Provider Demographics
NPI:1609461391
Name:MAHONEY, ROBERT COLE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COLE
Last Name:MAHONEY
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 1:11494 CAMINITO ELADO
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2117
Mailing Address - Country:US
Mailing Address - Phone:619-300-4849
Mailing Address - Fax:
Practice Address - Street 1:11494 CAMINITO ELADO
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-2117
Practice Address - Country:US
Practice Address - Phone:619-300-4849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist