Provider Demographics
NPI:1295786531
Name:MAST, ADAM LEE (PT, MPT, OCS)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:LEE
Last Name:MAST
Suffix:
Gender:M
Credentials:PT, MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10630 DEAN MARTIN DR STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-3595
Mailing Address - Country:US
Mailing Address - Phone:725-254-1330
Mailing Address - Fax:725-254-1331
Practice Address - Street 1:10630 DEAN MARTIN DR STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-3595
Practice Address - Country:US
Practice Address - Phone:725-254-1330
Practice Address - Fax:725-254-1331
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39022251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV250003652Medicaid
IN200671190Medicaid