Provider Demographics
NPI:1790140895
Name:MASON, ANGELA (DPT/OT)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:DPT/OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 MARINA DEL RAY LN UNIT 1
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-8452
Mailing Address - Country:US
Mailing Address - Phone:706-589-4368
Mailing Address - Fax:
Practice Address - Street 1:899 MARINA DEL RAY LN UNIT 1
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-8452
Practice Address - Country:US
Practice Address - Phone:706-589-4368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-27995225100000X
HIPT-4031225100000X
HIOT-1268225X00000X
FLOT14765225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL105248600Medicaid