=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578424826
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MASON SCOTT MARSHALL DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2025
-----------------------------------------------------
Last Update Date | 11/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6605 NICOLLET AVE
-----------------------------------------------------
City | RICHFIELD
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55423-2463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-872-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7116 RICE LAKE DR
-----------------------------------------------------
City | LINO LAKES
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55014-1249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-252-8326
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 14123
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------