Provider Demographics
NPI:1689876534
Name:MAHAN, KATHRYN ELIZABETH (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:MAHAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4605 NE FREMONT ST
Mailing Address - Street 2:SUITE #208
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-1707
Mailing Address - Country:US
Mailing Address - Phone:503-288-5957
Mailing Address - Fax:
Practice Address - Street 1:4605 NE FREMONT ST
Practice Address - Street 2:SUITE #208
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1707
Practice Address - Country:US
Practice Address - Phone:503-288-5957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR11692172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist