Provider Demographics
NPI:1184714909
Name:MASON, ROGER (PT)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:MASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:651 S CENTER AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2811
Practice Address - Country:US
Practice Address - Phone:814-443-0789
Practice Address - Fax:814-443-4924
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003196L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA762952OtherHIGHMARK BLUE SHIELD
PA5303609OtherAETNA
PA116951OtherHEALTH AMER/HEALTH ASSUR.
PAMA762952OtherHIGHMARK BLUE SHIELD