Provider Demographics
NPI:1780387274
Name:MASON, ANNEMARIE DANIELLE (PTA)
Entity type:Individual
Prefix:
First Name:ANNEMARIE
Middle Name:DANIELLE
Last Name:MASON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BENT TREE DR APT 1B
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-6735
Mailing Address - Country:US
Mailing Address - Phone:740-816-7799
Mailing Address - Fax:
Practice Address - Street 1:1198 SMILEY AVE STE F
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1866
Practice Address - Country:US
Practice Address - Phone:513-671-6362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA11483225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant