Provider Demographics
NPI:1447801253
Name:MASON, HAWK P (LMT)
Entity Type:Individual
Prefix:
First Name:HAWK
Middle Name:P
Last Name:MASON
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 GALAXY DR NE STE 301
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4754
Mailing Address - Country:US
Mailing Address - Phone:360-456-1444
Mailing Address - Fax:360-456-1883
Practice Address - Street 1:1445 GALAXY DR NE STE 301
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4754
Practice Address - Country:US
Practice Address - Phone:360-456-1444
Practice Address - Fax:360-456-1883
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60982973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist