Healthcare Provider Details

I. General information

NPI: 1497032031
Provider Name (Legal Business Name): RITA M. MASON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2011
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S HIGHWAY 6
GRETNA NE
68028-7970
US

IV. Provider business mailing address

870 AGNEW RD
GREENWOOD NE
68366-3000
US

V. Phone/Fax

Practice location:
  • Phone: 402-332-3446
  • Fax:
Mailing address:
  • Phone: 402-944-2468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number499
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: