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General NPI Number Information
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NPI Number | 1699130534
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Entity Type | Individual
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Provider Name | KERRY MCMAHON PT, DPT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 12/18/2015
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Provider Practice Location Address
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Address Line | 3011 WILSHIRE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90403-2301
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Country | US
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Telephone | 131-026-4838
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Fax |
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Provider Business Mailing Address
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Address Line | 14014 NW PASSAGE APT 143
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City | MARINA DEL REY
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State | CA
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Zip | 90292-7494
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Country | US
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Telephone | 510-579-4412
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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 | 43496
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License Number State | CA
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