Provider Demographics
NPI:1194900613
Name:MASON, MELODIE (LMT)
Entity type:Individual
Prefix:
First Name:MELODIE
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:MELODIE
Other - Middle Name:
Other - Last Name:WOHLFIEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:9948 GROVE DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34654-3403
Mailing Address - Country:US
Mailing Address - Phone:727-869-4801
Mailing Address - Fax:727-862-2703
Practice Address - Street 1:9948 GROVE DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34654-3403
Practice Address - Country:US
Practice Address - Phone:727-869-4801
Practice Address - Fax:727-862-2703
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM002250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist