Provider Demographics
NPI:1184208340
Name:MASON, SYRELLE JOVAN (LMT)
Entity Type:Individual
Prefix:
First Name:SYRELLE
Middle Name:JOVAN
Last Name:MASON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 UNIVERSITY CENTER DR APT 512
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-7476
Mailing Address - Country:US
Mailing Address - Phone:702-752-0845
Mailing Address - Fax:
Practice Address - Street 1:3830 UNIVERSITY CENTER DR APT 512
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-7476
Practice Address - Country:US
Practice Address - Phone:702-752-0845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT10828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist