Provider Demographics
NPI:1891021226
Name:JANET MAHONEY PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:JANET MAHONEY PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:517-896-8551
Mailing Address - Street 1:1334 MARBLE RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-2833
Mailing Address - Country:US
Mailing Address - Phone:517-896-8551
Mailing Address - Fax:888-683-1134
Practice Address - Street 1:4111 OKEMOS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3235
Practice Address - Country:US
Practice Address - Phone:517-896-8551
Practice Address - Fax:888-863-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501001955261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy