Basic Information
| Provider Information | |||||||||
| NPI: | 1306885991 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MASON | ||||||||
| FirstName: | MELINDA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5210 CORPORATE CENTER LOOP SE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | LACEY | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985035952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604558155 | ||||||||
| FaxNumber: | 3604556155 | ||||||||
| Practice Location | |||||||||
| Address1: | 6981 LITTLEROCK RD SW | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985127226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603527352 | ||||||||
| FaxNumber: | 3603527680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/16/2009 | ||||||||
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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 | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0169442 | 01 | WA | DEPT. OF LABOR & INDUSTRY | OTHER | 7110MA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 3455MA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 7574020 | 01 | WA | AETNA | OTHER | 8330979 | 05 | WA | MEDICAID | 8934744 | 01 | WA | L&I CRIME VICTIMS | OTHER | P00008119 | 01 | WA | RAILROAD MEDICARE | OTHER | 710883456-98501-A003 | 01 | WA | TRICARE | OTHER | 710883456-98512-A003 | 01 | WA | TRICARE | OTHER |