Provider Demographics
NPI:1477951838
Name:MASON, KELLY MCKINNEY (PT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MCKINNEY
Last Name:MASON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13808 WILD TURKEY PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-3336
Mailing Address - Country:US
Mailing Address - Phone:512-947-4280
Mailing Address - Fax:
Practice Address - Street 1:13808 WILD TURKEY PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-3336
Practice Address - Country:US
Practice Address - Phone:512-947-4280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1073435225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist