Provider Demographics
NPI:1841333127
Name:MASCARENAS, JEREMY (PT)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:MASCARENAS
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 1:6357 E CAROLINA DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-1933
Mailing Address - Country:US
Mailing Address - Phone:602-241-3145
Mailing Address - Fax:602-241-3146
Practice Address - Street 1:539 E GLENDALE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-4900
Practice Address - Country:US
Practice Address - Phone:602-241-3145
Practice Address - Fax:602-241-3146
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist