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NPI Code Detail

MEDICARE: LUCY M MAHON PT

MEDICARE:   LUCY M MAHON  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist4511SC

General Provider Information

NPI Number : 1083649685
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCY M MAHON PT
Provider Business Mailing Address
First Line : 1 BISHOP GADSDEN WAY
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-3506
Country : US
Telephone Number : 843-406-6302
Fax Number : 843-406-6540
Provider Business Practice Location Address
First Line : 1 BISHOP GADSDEN WAY
Second Line :
City : CHARLESTON
State : SC
Zip : 29412-3506
Country : US
Telephone Number : 843-406-6302
Fax Number : 843-406-6540
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2006
Last Update Date : 07/09/2007

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Directions to “ LUCY M MAHON PT” Practice Location

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