Provider Demographics
NPI:1841393048
Name:MASON, MELANIE FUGATE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:FUGATE
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 1:5507 RICH PATCH RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-6507
Mailing Address - Country:US
Mailing Address - Phone:540-747-2366
Mailing Address - Fax:
Practice Address - Street 1:601 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLIFTON FORGE
Practice Address - State:VA
Practice Address - Zip Code:24422-1759
Practice Address - Country:US
Practice Address - Phone:540-863-1620
Practice Address - Fax:540-863-1625
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002640225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004978358Medicaid
VA240741OtherANTHEM BCBS
VA541217983OtherTAX ID