MEDICARE: TARA MASON

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	1044352	TX

General Provider Information

NPI Number	:	1962890905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA MASON

Provider Business Mailing Address
First Line	:	9024 BLUE RIDGE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7325
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9024 BLUE RIDGE TRL
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-7325
Country	:	US
Telephone Number	:	817-480-6125
Fax Number	:

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

Provider Enumeration Date	:	12/29/2014
Last Update Date	:	12/29/2014

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Directions to “ TARA MASON ” Practice Location

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