MEDICARE: MS. JOANNA MARIE MCMAHAN 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	1135952	TX

General Provider Information

NPI Number	:	1629216106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOANNA MARIE MCMAHAN PT

Provider Business Mailing Address
First Line	:	1130 BEACHVIEW ST
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75218-3700
Country	:	US
Telephone Number	:	214-324-5851
Fax Number	:	214-324-5728

Provider Business Practice Location Address
First Line	:	1130 BEACHVIEW ST
Second Line	:	SUITE 120
City	:	DALLAS
State	:	TX
Zip	:	75218-3700
Country	:	US
Telephone Number	:	214-324-5851
Fax Number	:	214-324-5728

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

Provider Enumeration Date	:	01/22/2009
Last Update Date	:	08/09/2013

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