Provider Demographics
NPI:1639271547
Name:MAST, JANICE A (PT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:MAST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8902 N MERIDIAN ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-581-1890
Mailing Address - Fax:317-581-2436
Practice Address - Street 1:320 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9493
Practice Address - Country:US
Practice Address - Phone:317-581-1890
Practice Address - Fax:317-581-2436
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05001196A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN192990MMedicare PIN