MEDICARE: JOANNA MASTALERZ

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	2232	TN

General Provider Information

NPI Number	:	1376917914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA MASTALERZ

Provider Business Mailing Address
First Line	:	1810 SHADY BROOK ST
Second Line	:	SUITE 3
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1810 SHADY BROOK ST
Second Line	:	SUITE 3
City	:	COLUMBIA
State	:	TN
Zip	:	38401-3993
Country	:	US
Telephone Number	:	931-388-8500
Fax Number	:

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

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	11/19/2015

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Directions to “ JOANNA MASTALERZ ” Practice Location

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