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General NPI Number Information
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NPI Number | 1568585552
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Entity Type | Individual
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Provider Name | NANCY ELLEN MASON PTA
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Gender | Female
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 51-55 NORTH ROUTE 9W
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City | WEST HAVERSTRAW
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State | NY
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Zip | 10993
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Country | US
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Telephone | 845-786-4617
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Fax |
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Provider Business Mailing Address
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Address Line | 103 CADMAN AVE
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City | BABYLON
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State | NY
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Zip | 11702-1605
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Country | US
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Telephone | 631-422-0417
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 003324-1
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License Number State | NY
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