Provider Demographics
NPI:1871902536
Name:MAHONEY, MEGAN JUNE (PT)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:JUNE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:JUNE
Other - Last Name:GASKILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:301 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:AZ
Mailing Address - Zip Code:86046-2324
Mailing Address - Country:US
Mailing Address - Phone:928-635-7850
Mailing Address - Fax:
Practice Address - Street 1:1 CLINIC RD.
Practice Address - Street 2:
Practice Address - City:GRAND CANYON
Practice Address - State:AZ
Practice Address - Zip Code:86023
Practice Address - Country:US
Practice Address - Phone:928-638-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11043PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist