Provider Demographics
NPI:1699959320
Name:MAHLOW, PAUL-WAYNE JOHNSON (MA, ATC, CSCS)
Entity type:Individual
Prefix:MR
First Name:PAUL-WAYNE
Middle Name:JOHNSON
Last Name:MAHLOW
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Gender:M
Credentials:MA, ATC, CSCS
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Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-293-7767
Mailing Address - Fax:408-294-6595
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-293-7767
Practice Address - Fax:408-294-6595
Is Sole Proprietor?:No
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer