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NPI Code Detail

MEDICARE: DYLAN MASCARENAS

MEDICARE: DYLAN MASCARENAS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist292281CA
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1386186385
Entity Type Code : Individual
Provider Name (Legal Business Name) : DYLAN MASCARENAS
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5619 CAROLINA BEACH RD STE 120
Second Line :
City : WILMINGTON
State : NC
Zip : 28412-2815
Country : US
Telephone Number : 910-790-1976
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2016
Last Update Date : 01/22/2021

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Directions to “ DYLAN MASCARENAS ” Practice Location

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