Healthcare Provider Details

I. General information

NPI: 1295786531
Provider Name (Legal Business Name): ADAM LEE MAST PT, MPT, OCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 DEAN MARTIN DR STE 120
LAS VEGAS NV
89141-3595
US

IV. Provider business mailing address

10630 DEAN MARTIN DR STE 120
LAS VEGAS NV
89141-3595
US

V. Phone/Fax

Practice location:
  • Phone: 725-254-1330
  • Fax: 725-254-1331
Mailing address:
  • Phone: 725-254-1330
  • Fax: 725-254-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number3902
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: