Healthcare Provider Details

I. General information

NPI: 1770493348
Provider Name (Legal Business Name): BRENNA MAHONEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 W BASELINE RD STE 140
MESA AZ
85202-5821
US

IV. Provider business mailing address

12530 CAROW CIR
FRAZEE MN
56544-8600
US

V. Phone/Fax

Practice location:
  • Phone: 480-820-7675
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14391
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: