Provider Demographics
NPI:1598739898
Name:MASON, JAMIE LYNNETTE (PT)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:LYNNETTE
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 1:2296 CHELSEY CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1160
Mailing Address - Country:US
Mailing Address - Phone:805-482-9565
Mailing Address - Fax:
Practice Address - Street 1:1100 N VENTURA RD
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-3841
Practice Address - Country:US
Practice Address - Phone:805-983-0811
Practice Address - Fax:805-983-1481
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 155952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT15595AMedicare ID - Type UnspecifiedPROVIDER NUMBER