Healthcare Provider Details

I. General information

NPI: 1649396656
Provider Name (Legal Business Name): JANET L MAHONEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANET L HALPIN PT

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 05/07/2023
Certification Date: 05/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

63 PARKER RIDGE LANE SUITE 290
BLUE HILL ME
04614-2123
US

IV. Provider business mailing address

16623 W RIVER ROAD
INGLIS FL
34449-5116
US

V. Phone/Fax

Practice location:
  • Phone: 833-833-3258
  • Fax:
Mailing address:
  • Phone: 978-491-8084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number5479
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: