Provider Demographics
NPI:1114305703
Name:MASON, COURTNEY
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MASON RUN RD
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15832-4634
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 PINE ST
Practice Address - Street 2:
Practice Address - City:RENOVO
Practice Address - State:PA
Practice Address - Zip Code:17764-1618
Practice Address - Country:US
Practice Address - Phone:570-923-1000
Practice Address - Fax:570-923-1812
Is Sole Proprietor?:No
Enumeration Date:2015-05-14
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI004251225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant