Provider Demographics
NPI:1447495445
Name:MAHONEY, ANNE (LMT)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 MILL ST
Mailing Address - Street 2:VILLAGE GLEN TENNIS CLUB
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5549
Mailing Address - Country:US
Mailing Address - Phone:716-812-7071
Mailing Address - Fax:
Practice Address - Street 1:162 MILL ST
Practice Address - Street 2:VILLAGE GLEN TENNIS CLUB
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5549
Practice Address - Country:US
Practice Address - Phone:716-812-7071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011828OtherNYS LICENSED MASSAGE THERAPIST