Provider Demographics
NPI:1295861938
Name:MASTERS, JANELLE LORRAINE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:LORRAINE
Last Name:MASTERS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19003 LONG POND LN
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-8221
Mailing Address - Country:US
Mailing Address - Phone:704-576-7973
Mailing Address - Fax:
Practice Address - Street 1:2826 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1386
Practice Address - Country:US
Practice Address - Phone:704-366-5521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005011136225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2199934741Medicare ID - Type UnspecifiedMEDICARE NUMBER