Provider Demographics
NPI:1891479127
Name:GEISTWEIDT, MASON
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:GEISTWEIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 ALEXANDER RD APT 401
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-5198
Mailing Address - Country:US
Mailing Address - Phone:972-322-0606
Mailing Address - Fax:
Practice Address - Street 1:826 ALEXANDER RD APT 401
Practice Address - Street 2:
Practice Address - City:STEPHENVILLE
Practice Address - State:TX
Practice Address - Zip Code:76401-5198
Practice Address - Country:US
Practice Address - Phone:972-322-0606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer