Provider Demographics
NPI:1942479902
Name:MASON, KURT A (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:A
Last Name:MASON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2499 E JOLIET HWY
Practice Address - Street 2:UNIT 112
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-2592
Practice Address - Country:US
Practice Address - Phone:815-462-9420
Practice Address - Fax:815-462-9421
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-012398225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00651124Medicare PIN
ILR00227Medicare PIN