Provider Demographics
NPI:1063617686
Name:MCMAHON, MARIE R (LMT)
Entity type:Individual
Prefix:MS
First Name:MARIE
Middle Name:R
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:MARIE
Other - Middle Name:R
Other - Last Name:HAYMAN-MCMAHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:PO BOX 105
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:NY
Mailing Address - Zip Code:12941-0105
Mailing Address - Country:US
Mailing Address - Phone:518-586-1823
Mailing Address - Fax:
Practice Address - Street 1:13036 NYS 9N
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:NY
Practice Address - Zip Code:12941
Practice Address - Country:US
Practice Address - Phone:518-586-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019398172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist