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General NPI Number Information
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NPI Number | 1902140510
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Entity Type | Individual
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Provider Name | ADELA B MASCARENAS PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 179 BRIDGE ST
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City | LAS VEGAS
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State | NM
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Zip | 87701-3495
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Country | US
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Telephone | 505-426-2318
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Fax |
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Provider Business Mailing Address
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Address Line | 23760 SE TILLSTROM RD
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City | DAMASCUS
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State | OR
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Zip | 97089-6174
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Country | US
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Telephone | 503-544-2525
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 4215
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License Number State | NM
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