Provider Demographics
NPI:1427261114
Name:MAHONEY, BRIAN E (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:E
Last Name:MAHONEY
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 SCHAFER DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:AR
Mailing Address - Zip Code:72024
Mailing Address - Country:US
Mailing Address - Phone:501-425-4323
Mailing Address - Fax:
Practice Address - Street 1:8907 KANIS ROAD
Practice Address - Street 2:STE. 400
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205
Practice Address - Country:US
Practice Address - Phone:501-663-4320
Practice Address - Fax:501-978-1452
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAT 2272255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARAT 227OtherATHLETIC TRAINING LIC.