Provider Demographics
NPI:1750481503
Name:MAHONEY, ANDREA SPENCER (PT)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:SPENCER
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:A
Other - Middle Name:SPENCER
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 OHIO PIKE
Mailing Address - Street 2:STE 108
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45255-3372
Mailing Address - Country:US
Mailing Address - Phone:513-295-2964
Mailing Address - Fax:
Practice Address - Street 1:431 OHIO PIKE
Practice Address - Street 2:STE 108
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3372
Practice Address - Country:US
Practice Address - Phone:513-528-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 011527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2695794Medicaid
OH2695794Medicaid
OH4192711Medicare PIN