Provider Demographics
NPI:1346481694
Name:MASON, MARY BETH (PT/ATC)
Entity Type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:PT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:678 BROOKGREEN LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1952
Mailing Address - Country:US
Mailing Address - Phone:859-263-9229
Mailing Address - Fax:
Practice Address - Street 1:261 RUCCIO WAY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-3662
Practice Address - Country:US
Practice Address - Phone:859-266-0404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist