Healthcare Provider Details

I. General information

NPI: 1710983440
Provider Name (Legal Business Name): JOE TODD MASON MSPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: J TODD MASON MSPT

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 RUSSELLVILLE RD
BOWLING GREEN KY
42101-5024
US

IV. Provider business mailing address

2235 RUSSELLVILLE RD
BOWLING GREEN KY
42101-5024
US

V. Phone/Fax

Practice location:
  • Phone: 270-781-1151
  • Fax: 270-781-5990
Mailing address:
  • Phone: 270-781-1151
  • Fax: 270-781-5990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number003509
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: