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NPI Code Detail

MEDICARE: DEREK ALLEN MASON

MEDICARE: DEREK ALLEN MASON
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
1225200000XPhysical Therapy Assistant160005367IL

General Provider Information

NPI Number : 1972893931
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEREK ALLEN MASON
Provider Business Mailing Address
First Line : 301 E COLORADO AVE
Second Line :
City : CASEY
State : IL
Zip : 62420-1510
Country : US
Telephone Number : 217-232-4449
Fax Number :
Provider Business Practice Location Address
First Line : 2649 E 75TH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60649-3835
Country : US
Telephone Number : 773-356-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2011
Last Update Date : 04/12/2011

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