Provider Demographics
NPI:1811649072
Name:MCMAHON, KATELYN MARIE (DPT, PT)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
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Mailing Address - Street 1:1411 FALLS AVE E STE 401
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-3455
Mailing Address - Country:US
Mailing Address - Phone:208-516-1204
Mailing Address - Fax:208-516-1204
Practice Address - Street 1:1615 CURLEW DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-4718
Practice Address - Country:US
Practice Address - Phone:208-516-1204
Practice Address - Fax:208-516-1204
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2024-12-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN12075225100000X
ID7371840225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist