Provider Demographics
NPI:1093187999
Name:MASON PHYSICAL THERAPY AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MASON PHYSICAL THERAPY AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:WADE
Authorized Official - Last Name:ROHLF
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:830-329-2819
Mailing Address - Street 1:PO BOX 2612
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-1924
Mailing Address - Country:US
Mailing Address - Phone:830-329-2819
Mailing Address - Fax:
Practice Address - Street 1:216 W COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:TX
Practice Address - Zip Code:76856-3104
Practice Address - Country:US
Practice Address - Phone:325-294-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-30
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104370261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX460826Medicare UPIN