Provider Demographics
NPI:1588039804
Name:RAASCH-MASON, PRISCILLA LOU (PT, MSPT, MS)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:LOU
Last Name:RAASCH-MASON
Suffix:
Gender:F
Credentials:PT, MSPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CYPRESS VILLAGE BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33573
Mailing Address - Country:US
Mailing Address - Phone:813-633-0669
Mailing Address - Fax:813-633-0881
Practice Address - Street 1:827 CYPRESS VILLAGE BLVD.
Practice Address - Street 2:SUITE A
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33573
Practice Address - Country:US
Practice Address - Phone:813-633-0669
Practice Address - Fax:813-633-0881
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29669225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist