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General NPI Number Information
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NPI Number | 1891021226
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Entity Type | Organization
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Legal Business Name | JANET MAHONEY PHYSICAL THERAPY, LLC
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Dates
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Enumeration Date | 10/20/2009
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Last Update Date | 10/20/2009
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Provider Practice Location Address
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Address Line | 4111 OKEMOS RD SUITE 102
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City | OKEMOS
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State | MI
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Zip | 48864-3235
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Country | US
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Telephone | 517-896-8551
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Fax | 888-863-1134
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Provider Business Mailing Address
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Address Line | 1334 MARBLE RD
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City | EAST LANSING
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State | MI
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Zip | 48823-2833
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Country | US
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Telephone | 517-896-8551
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Fax | 888-683-1134
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Authorized Official
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Title or Position | OWNER
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Name | JANET LYNN MAHONEY
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Credential | P.T.
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Telephone | 517-896-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 5501001955
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License Number State | MI
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