Provider Demographics
NPI:1841792843
Name:MAHONEY, KYLE RILEY (PT)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:RILEY
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 1:681 FALMOUTH RD STE E21
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-6316
Mailing Address - Country:US
Mailing Address - Phone:508-477-5670
Mailing Address - Fax:508-539-1790
Practice Address - Street 1:681 FALMOUTH RD STE E21
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-6316
Practice Address - Country:US
Practice Address - Phone:508-477-5670
Practice Address - Fax:508-539-1790
Is Sole Proprietor?:No
Enumeration Date:2018-03-06
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25292225100000X
CAPT294903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist