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NPI Code Detail

MEDICARE: SHANNON MAHONEY

MEDICARE: SHANNON MAHONEY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant9858OR

General Provider Information

NPI Number : 1194333906
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANNON MAHONEY
Provider Business Mailing Address
First Line : 8810 SE SUNNYBROOK BLVD STE 100
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-6805
Country : US
Telephone Number : 503-607-2226
Fax Number :
Provider Business Practice Location Address
First Line : 8810 SE SUNNYBROOK BLVD STE 100
Second Line :
City : CLACKAMAS
State : OR
Zip : 97015-6805
Country : US
Telephone Number : 503-607-2226
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/17/2020
Last Update Date : 07/17/2020

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Directions to “ SHANNON MAHONEY ” Practice Location

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