Healthcare Provider Details

I. General information

NPI: 1306885991
Provider Name (Legal Business Name): MELINDA L MASON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6981 LITTLEROCK RD SW SUITE 105
TUMWATER WA
98512-7226
US

IV. Provider business mailing address

5210 CORPORATE CENTER LOOP SE SUITE D
LACEY WA
98503-5952
US

V. Phone/Fax

Practice location:
  • Phone: 360-352-7352
  • Fax: 360-352-7680
Mailing address:
  • Phone: 360-455-8155
  • Fax: 360-455-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: