MEDICARE: BRENT MCMAHON PT

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
1	225100000X	Physical Therapist	293789	CA

General Provider Information

NPI Number	:	1356852883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENT MCMAHON PT

Provider Business Mailing Address
First Line	:	615 S CITRUS ST
Second Line	:
City	:	WEST COVINA
State	:	CA
Zip	:	91791-2844
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2327 HUNTINGTON DR
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2642
Country	:	US
Telephone Number	:	626-395-0884
Fax Number	:	626-395-0884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2017
Last Update Date	:	12/22/2023

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