Provider Demographics
NPI:1790050490
Name:MASON VALLEY PHYSICAL THERAPY, INC.
Entity Type:Organization
Organization Name:MASON VALLEY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:775-463-4500
Mailing Address - Street 1:513 W BRIDGE ST
Mailing Address - Street 2:STE E
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447-2695
Mailing Address - Country:US
Mailing Address - Phone:775-463-4500
Mailing Address - Fax:775-463-4545
Practice Address - Street 1:513 W BRIDGE ST
Practice Address - Street 2:STE E
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447-2695
Practice Address - Country:US
Practice Address - Phone:775-463-4500
Practice Address - Fax:775-463-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1797225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty