Provider Demographics
NPI:1780849794
Name:ANTHONY, MICHELLE MAHONEY (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:MAHONEY
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 COOL SPRINGS BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7257
Mailing Address - Country:US
Mailing Address - Phone:615-778-4066
Mailing Address - Fax:615-778-9114
Practice Address - Street 1:2171 WOODWARD ST # B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-1049
Practice Address - Country:US
Practice Address - Phone:512-440-0555
Practice Address - Fax:512-440-1113
Is Sole Proprietor?:No
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist