Healthcare Provider Details

I. General information

NPI: 1023027588
Provider Name (Legal Business Name): PAULINE A MAHONEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 02/17/2020
Certification Date: 02/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16838 E PALISADES BLVD STE B121
FOUNTAIN HILLS AZ
85268-3789
US

IV. Provider business mailing address

9097 E DESERT COVE AVE STE 110
SCOTTSDALE AZ
85260-6276
US

V. Phone/Fax

Practice location:
  • Phone: 480-837-2595
  • Fax: 480-837-2773
Mailing address:
  • Phone: 480-551-4967
  • Fax: 480-860-0356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5360
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: