Provider Demographics
NPI:1699833061
Name:MASON, CURTIS A (DPT)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:A
Last Name:MASON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEY AVE
Mailing Address - Street 2:
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1840
Mailing Address - Country:US
Mailing Address - Phone:208-678-2155
Mailing Address - Fax:208-678-2153
Practice Address - Street 1:1200 OAKLEY AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1840
Practice Address - Country:US
Practice Address - Phone:208-678-2155
Practice Address - Fax:208-678-2153
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPT-2031225100000X
FLPT31411225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8082156Medicaid
ID8N843OtherBLUE CROSS
ID1652822Medicare UPIN