Basic Information
| Provider Information | |||||||||
| NPI: | 1114305703 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | COURTNEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80 MASON RUN RD | ||||||||
| Address2: | |||||||||
| City: | DRIFTWOOD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158324634 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1001 PINE ST | ||||||||
| Address2: | |||||||||
| City: | RENOVO | ||||||||
| State: | PA | ||||||||
| PostalCode: | 177641618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5709231000 | ||||||||
| FaxNumber: | 5709231812 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2015 | ||||||||
| LastUpdateDate: | 05/14/2015 | ||||||||
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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 | 225200000X | TEI004251 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.