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General NPI Number Information
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NPI Number | 1124201330
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Entity Type | Individual
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Provider Name | MATTHEW O'MAHONEY D.P.T.
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Gender | Male
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Dates
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Enumeration Date | 12/11/2007
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Last Update Date | 12/11/2007
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Provider Practice Location Address
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Address Line | 360 SAN MIGUEL DR 301
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7853
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Country | US
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Telephone | 714-759-0300
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Fax |
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Provider Business Mailing Address
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Address Line | 6 ALARIS AISLE
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City | IRVINE
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State | CA
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Zip | 92614-0268
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 34135
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License Number State | CA
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