Provider Demographics
NPI:1922781277
Name:LOAR, MASON ALEXANDER
Entity Type:Individual
Prefix:
First Name:MASON
Middle Name:ALEXANDER
Last Name:LOAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 PEOPLES DR STE 110
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-7622
Mailing Address - Country:US
Mailing Address - Phone:540-638-2478
Mailing Address - Fax:
Practice Address - Street 1:3221 PEOPLES DR STE 110
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-7622
Practice Address - Country:US
Practice Address - Phone:540-638-2478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD29565225100000X
VACP024496T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist