Individual
KELLY LYNN MAHONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MPT
Contact information
Practice address
2108 HUNTINGTON LN # A, REDONDO BEACH, CA 90278-4309
(310) 372-3292
Mailing address
2108 HUNTINGTON LN # A, REDONDO BEACH, CA 90278-4309
(310) 372-3292
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
PT21213
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT21213
PT LICENSE
CA
Enumeration date
03/09/2011
Last updated
03/09/2011
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