Provider Demographics
NPI:1104995513
Name:MAHFET, JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:MAHFET
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10817 SANTA MONICA BLVD
Mailing Address - Street 2:#300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4685
Mailing Address - Country:US
Mailing Address - Phone:310-474-8111
Mailing Address - Fax:
Practice Address - Street 1:10817 SANTA MONICA BLVD
Practice Address - Street 2:#300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4685
Practice Address - Country:US
Practice Address - Phone:310-474-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16360Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER
CAWPT7354AMedicare ID - Type UnspecifiedPROVIDER NUMBER