Provider Demographics
NPI:1659195113
Name:MASON, LYDIA GRACE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:GRACE
Last Name:MASON
Suffix:
Gender:F
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 1:1 H F BROWN WAY
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3889
Mailing Address - Country:US
Mailing Address - Phone:508-647-1633
Mailing Address - Fax:
Practice Address - Street 1:1 H F BROWN WAY
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3889
Practice Address - Country:US
Practice Address - Phone:508-647-1633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPTL28050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist