Provider Demographics
NPI:1912387960
Name:GIST, MASON (DPT)
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:GIST
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
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Mailing Address - Street 1:1900 LONG PRAIRIE RD
Mailing Address - Street 2:104
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4217
Mailing Address - Country:US
Mailing Address - Phone:972-724-2400
Mailing Address - Fax:972-724-2495
Practice Address - Street 1:3001 FM 2181
Practice Address - Street 2:150
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76210-2101
Practice Address - Country:US
Practice Address - Phone:940-498-4004
Practice Address - Fax:940-498-4008
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1259809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist