Provider Demographics
NPI:1518415009
Name:MASON, KATELYNNE ELIZABETH (CMT)
Entity Type:Individual
Prefix:
First Name:KATELYNNE
Middle Name:ELIZABETH
Last Name:MASON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 6TH ST
Mailing Address - Street 2:
Mailing Address - City:IRON GATE
Mailing Address - State:VA
Mailing Address - Zip Code:24448
Mailing Address - Country:US
Mailing Address - Phone:540-784-3424
Mailing Address - Fax:
Practice Address - Street 1:303 6TH ST
Practice Address - Street 2:
Practice Address - City:IRON GATE
Practice Address - State:VA
Practice Address - Zip Code:24448
Practice Address - Country:US
Practice Address - Phone:540-784-3424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019014103225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty