MEDICARE: MR. LIAM MAHONEY 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	2251X0800X	Orthopedic Physical Therapist	117696	MO

General Provider Information

NPI Number	:	1386953008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LIAM MAHONEY PT

Provider Business Mailing Address
First Line	:	600 OAKMONT LN
Second Line	:	STE 600C
City	:	WESTMONT
State	:	IL
Zip	:	60559-5548
Country	:	US
Telephone Number	:	630-575-1980
Fax Number	:	630-928-5080

Provider Business Practice Location Address
First Line	:	4004 PEACH CT
Second Line	:	SUITE H
City	:	COLUMBIA
State	:	MO
Zip	:	65203-3800
Country	:	US
Telephone Number	:	573-256-8100
Fax Number	:	573-256-8104

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

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	07/07/2020

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Directions to “ MR. LIAM MAHONEY PT” Practice Location

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