Provider Demographics
NPI:1023004074
Name:MASON, JOEL D (PT)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:MASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:240 N BLUFF BLVD SUITE 101
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52733-0337
Mailing Address - Country:US
Mailing Address - Phone:563-519-0242
Mailing Address - Fax:563-241-4353
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:PLAZA PHYSICAL THERAPY
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3471
Practice Address - Country:US
Practice Address - Phone:563-344-6645
Practice Address - Fax:563-441-7796
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03083225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0288779Medicaid
IA0288779Medicaid
P80276Medicare UPIN