Basic Information
| Provider Information | |||||||||
| NPI: | 1861612962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHON | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | JULIA | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5908 GUNBARREL AVE # B | ||||||||
| Address2: | |||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202994317 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BOULDER COMMUNITY HOSPITAL | ||||||||
| Address2: | N BROADWAY AND BALSAM AVE | ||||||||
| City: | BOULDER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 803019019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034402250 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 225100000X | 4557 | CO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.