Basic Information
| Provider Information | |||||||||
| NPI: | 1871876888 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | CHRISTINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | R.M.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8725 WADSWORTH BLVD | ||||||||
| Address2: | UNIT A | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800030928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034257298 | ||||||||
| FaxNumber: | 3039408330 | ||||||||
| Practice Location | |||||||||
| Address1: | 8725 WADSWORTH BLVD | ||||||||
| Address2: | UNIT A | ||||||||
| City: | ARVADA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800030928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034257298 | ||||||||
| FaxNumber: | 3039408330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 09/26/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 11088 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
ID Information
| ID | Type | State | Issuer | Description | 11088 | 01 | CO | COLORADO LICENSE/REGISTRATION NUMBER | OTHER |