Provider Demographics
NPI:1881946226
Name:MAHONEY, DARLENE MARIE (MS, PT)
Entity type:Individual
Prefix:
First Name:DARLENE
Middle Name:MARIE
Last Name:MAHONEY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2217
Mailing Address - Country:US
Mailing Address - Phone:860-633-2456
Mailing Address - Fax:
Practice Address - Street 1:827 MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2217
Practice Address - Country:US
Practice Address - Phone:860-916-7916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005057225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist