Provider Demographics
NPI:1003166794
Name:MASON, ALISON MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:MARIE
Last Name:MASON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:MARIE
Other - Last Name:SWANTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:371 RAY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3933
Mailing Address - Country:US
Mailing Address - Phone:207-797-2570
Mailing Address - Fax:
Practice Address - Street 1:371 RAY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3933
Practice Address - Country:US
Practice Address - Phone:207-797-2570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMT4704225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist