| Doctor Name: | COLLEEN MCMAHON |
| NPI Number: | 1407285281 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 004396 |
| Business Practice Address: | 2848 Middle Country Rd Lake Grove, NY - 117552104 |
| Business Phone Number: | 6316488835 |
| Business Fax Number: | 6312852124 |
| Mailing Address: | 18 Hamilton Pl, LAKE GROVE |
| State: | NY |
| Postal Code: | 117551915 |
| Phone Number: | 5164546387 |
| Fax Number: | 5164546303 |
| NPI Enumeration Date: | 11/02/2013 |
| NPI Last Update Date: | 11/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225700000X |
| License Number: | 004396 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Massage Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |