Individual
KAITLIN MAHONEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
250 S MAIN STREET, SUITE 224A, BLACKSBURG, VA 24060-4726
(540) 552-7133
(540) 552-7143
Mailing address
1924 ALCOA HWY # U-67, KNOXVILLE, TN 37920-1511
(865) 305-9350
(865) 305-9353
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
0102206749
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/10/2017
Last updated
03/14/2022
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