Provider Demographics
NPI:1023027588
Name:MAHONEY, PAULINE A (PT)
Entity type:Individual
Prefix:
First Name:PAULINE
Middle Name:A
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9097 E DESERT COVE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6276
Mailing Address - Country:US
Mailing Address - Phone:480-551-4967
Mailing Address - Fax:480-860-0356
Practice Address - Street 1:16838 E PALISADES BLVD STE B121
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3789
Practice Address - Country:US
Practice Address - Phone:480-837-2595
Practice Address - Fax:480-837-2773
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809494Medicaid
AZZ116404Medicare PIN