Provider Demographics
NPI:1245293976
Name:MAHONEY, KIMBERLEY A (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:A
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1285 HEMBREE RD
Mailing Address - Street 2:SUITE 200-D
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5720
Mailing Address - Country:US
Mailing Address - Phone:770-772-5540
Mailing Address - Fax:770-772-5541
Practice Address - Street 1:1285 HEMBREE RD
Practice Address - Street 2:SUITE 200-D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5720
Practice Address - Country:US
Practice Address - Phone:770-772-5540
Practice Address - Fax:770-772-5541
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0005422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic