Healthcare Provider Details

I. General information

NPI: 1841393048
Provider Name (Legal Business Name): MELANIE FUGATE MASON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 MAIN ST
CLIFTON FORGE VA
24422-1759
US

IV. Provider business mailing address

5507 RICH PATCH RD
COVINGTON VA
24426-6507
US

V. Phone/Fax

Practice location:
  • Phone: 540-863-1620
  • Fax: 540-863-1625
Mailing address:
  • Phone: 540-747-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305002640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: