Provider Demographics
NPI:1154652832
Name:MAST, KERI
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:MAST
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 1:10186 WOODLANDS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22834-2233
Mailing Address - Country:US
Mailing Address - Phone:540-833-8187
Mailing Address - Fax:
Practice Address - Street 1:1481 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22802-2433
Practice Address - Country:US
Practice Address - Phone:540-438-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305202865225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist