Provider Demographics
NPI:1679209761
Name:MCMAHAN, JUSTIN SCOTT (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:SCOTT
Last Name:MCMAHAN
Suffix:
Gender:M
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8088 N VOYAGER DR
Mailing Address - Street 2:
Mailing Address - City:CITRUS SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34433-5940
Mailing Address - Country:US
Mailing Address - Phone:352-464-3852
Mailing Address - Fax:
Practice Address - Street 1:8088 N VOYAGER DR
Practice Address - Street 2:
Practice Address - City:CITRUS SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34433-5940
Practice Address - Country:US
Practice Address - Phone:352-464-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL66352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer