Healthcare Provider Details

I. General information

NPI: 1174049324
Provider Name (Legal Business Name): MASON TREGONING DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S GATEWAY DR
MADERA CA
93637-3531
US

IV. Provider business mailing address

309 S GATEWAY DR
MADERA CA
93637-3531
US

V. Phone/Fax

Practice location:
  • Phone: 559-674-7201
  • Fax:
Mailing address:
  • Phone: 559-674-7201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPR293495
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: