Provider Demographics
NPI:1235309881
Name:MASHTALIER, WILLIAM BENNETT (MPT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENNETT
Last Name:MASHTALIER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3936 PHELAN RD
Mailing Address - Street 2:B-9
Mailing Address - City:PHELAN
Mailing Address - State:CA
Mailing Address - Zip Code:92371-4141
Mailing Address - Country:US
Mailing Address - Phone:760-220-6932
Mailing Address - Fax:760-948-9555
Practice Address - Street 1:3936 PHELAN RD
Practice Address - Street 2:B-9
Practice Address - City:PHELAN
Practice Address - State:CA
Practice Address - Zip Code:92371-4141
Practice Address - Country:US
Practice Address - Phone:760-220-6932
Practice Address - Fax:760-948-9555
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist