MEDICARE: LAUREN DANIELLE MASI MPT, OCS, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	048787	NY
2	2251E1300X	Clinical Electrophysiology Physical Therapist	PT33179	CA
3	2251E1300X	Clinical Electrophysiology Physical Therapist	048787	NY
4	225100000X	Physical Therapist	PT33179	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	048787	OTHER	NY	NEW YORK STATE EDUCATION DEPARTMENT OFFICE OF THE PROFESSIONS
2	PT33179	OTHER	CA	LICENSE NUMBER

General Provider Information

NPI Number	:	1275615940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DANIELLE MASI MPT, OCS, ATC

Provider Business Mailing Address
First Line	:	380 CIVIC DR STE 100
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1946
Country	:	US
Telephone Number	:	818-943-7480
Fax Number	:	855-814-4495

Provider Business Practice Location Address
First Line	:	380 CIVIC DR STE 100
Second Line	:
City	:	PLEASANT HILL
State	:	CA
Zip	:	94523-1946
Country	:	US
Telephone Number	:	818-943-7480
Fax Number	:	855-814-4495

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/31/2023

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