1972923399 NPI number — MRS. AMANDA JEAN MCMAHAN MS, AT, ATC

Table of content: MRS. AMANDA JEAN MCMAHAN MS, AT, ATC (NPI 1972923399)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972923399 NPI number — MRS. AMANDA JEAN MCMAHAN MS, AT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCMAHAN
Provider First Name:
AMANDA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, AT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOHLS
Provider Other First Name:
AMANDA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, AT, ATC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972923399
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 EAST WASHINGTON STREET
Provider Second Line Business Mailing Address:
MEDINA HOSPITAL REHAB AND SPORTS THERAPY
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-725-1000
Provider Business Mailing Address Fax Number:
330-721-4913

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
262 STATE ROUTE 58
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SULLIVAN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44880-9762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-653-1809
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 283X00000X , with the licence number:  AT. 003709 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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