Provider Demographics
NPI:1871589424
Name:MAHONEY, SANDRA (PT)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2257 NUREMBERG BLVD
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33983-2649
Mailing Address - Country:US
Mailing Address - Phone:941-255-1891
Mailing Address - Fax:941-255-1891
Practice Address - Street 1:2257 NUREMBERG BLVD
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-2649
Practice Address - Country:US
Practice Address - Phone:941-255-1891
Practice Address - Fax:941-255-1891
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY0365OtherBCBS
FLY0365OtherBCBS