Provider Demographics
NPI:1922049907
Name:MASON, SUSAN PAM (PT, MED)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:PAM
Last Name:MASON
Suffix:
Gender:F
Credentials:PT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 LOOMIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WATERBURY CENTER
Mailing Address - State:VT
Mailing Address - Zip Code:05677-8257
Mailing Address - Country:US
Mailing Address - Phone:802-244-5516
Mailing Address - Fax:802-879-5963
Practice Address - Street 1:1725 LOOMIS HILL RD
Practice Address - Street 2:
Practice Address - City:WATERBURY CENTER
Practice Address - State:VT
Practice Address - Zip Code:05677-8257
Practice Address - Country:US
Practice Address - Phone:802-244-5516
Practice Address - Fax:802-879-5963
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400002226225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist