Provider Demographics
NPI:1407399256
Name:MASON, ANTWON (LMT)
Entity Type:Individual
Prefix:
First Name:ANTWON
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:ANTWON
Other - Middle Name:
Other - Last Name:MASON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1340 S LAUREL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8304
Mailing Address - Country:US
Mailing Address - Phone:606-388-6822
Mailing Address - Fax:
Practice Address - Street 1:1340 S LAUREL RD STE 104
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8304
Practice Address - Country:US
Practice Address - Phone:606-388-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist