Provider Demographics
NPI:1336252022
Name:MAHON, PEGGY MARY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:MARY
Last Name:MAHON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4896 S BRIGHT ANGEL TRL
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-8369
Mailing Address - Country:US
Mailing Address - Phone:928-774-4307
Mailing Address - Fax:
Practice Address - Street 1:1485 N. TURQUOISE DRIVE
Practice Address - Street 2:SUITE 220
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1395
Practice Address - Country:US
Practice Address - Phone:928-774-6626
Practice Address - Fax:928-214-3277
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ15912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ82876Medicare ID - Type Unspecified