Healthcare Provider Details

I. General information

NPI: 1396021978
Provider Name (Legal Business Name): MICHAEL CHRISTOPHER MCMAHON P.T
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 10W
BILLINGS MT
59101-7503
US

IV. Provider business mailing address

2900 12TH AVE N STE 10W
BILLINGS MT
59101-7503
US

V. Phone/Fax

Practice location:
  • Phone: 406-238-6400
  • Fax: 406-238-6464
Mailing address:
  • Phone: 406-238-6400
  • Fax: 406-238-6464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1922
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: