Provider Demographics
NPI:1386274454
Name:MCMAHON, JOSIE (LAT, AT)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:LAT, AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 E FRANKLIN ST APT 320
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7461
Mailing Address - Country:US
Mailing Address - Phone:804-720-3795
Mailing Address - Fax:
Practice Address - Street 1:2005 E FRANKLIN ST APT 320
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7461
Practice Address - Country:US
Practice Address - Phone:804-720-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260010502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty