Provider Demographics
NPI:1790494052
Name:MCMAHON, PAUL LYLE JR (PT, DPT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:LYLE
Last Name:MCMAHON
Suffix:JR
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3409 SINGING HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106
Mailing Address - Country:US
Mailing Address - Phone:712-202-0702
Mailing Address - Fax:
Practice Address - Street 1:3409 SINGING HILLS BLVD
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106
Practice Address - Country:US
Practice Address - Phone:712-202-0702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2025-08-20
Deactivation Date:2025-06-13
Deactivation Code:
Reactivation Date:2025-08-20
Provider Licenses
StateLicense IDTaxonomies
IA132467225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist