Provider Demographics
NPI:1417326745
Name:MASON, MYRA
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 CONCORD PKWY S
Mailing Address - Street 2:SUITE 110 B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6730
Mailing Address - Country:US
Mailing Address - Phone:704-720-4400
Mailing Address - Fax:
Practice Address - Street 1:280 CONCORD PKWY S
Practice Address - Street 2:SUITE 110 B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6730
Practice Address - Country:US
Practice Address - Phone:704-720-4400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP9246225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist