Provider Demographics
NPI:1457807372
Name:LIBERATORE, MASON (PT DPT)
Entity type:Individual
Prefix:DR
First Name:MASON
Middle Name:
Last Name:LIBERATORE
Suffix:
Gender:
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 1:30 ELM PLZ
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4949
Mailing Address - Country:US
Mailing Address - Phone:207-735-3797
Mailing Address - Fax:
Practice Address - Street 1:30 ELM PLZ
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4949
Practice Address - Country:US
Practice Address - Phone:207-830-0546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4479225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist