Provider Demographics
NPI:1821122490
Name:MAHONEY, JOHN C (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MAHONEY
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 1:271 GIBSON RD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6117
Mailing Address - Country:US
Mailing Address - Phone:410-437-8998
Mailing Address - Fax:
Practice Address - Street 1:3104 LORD BALTIMORE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2898
Practice Address - Country:US
Practice Address - Phone:410-298-0990
Practice Address - Fax:410-298-0871
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist