Provider Demographics
NPI:1306885991
Name:MASON, MELINDA L (PT)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:L
Last Name:MASON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5210 CORPORATE CENTER LOOP SE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5952
Mailing Address - Country:US
Mailing Address - Phone:360-455-8155
Mailing Address - Fax:360-455-6155
Practice Address - Street 1:6981 LITTLEROCK RD SW
Practice Address - Street 2:SUITE 105
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7226
Practice Address - Country:US
Practice Address - Phone:360-352-7352
Practice Address - Fax:360-352-7680
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0169442OtherDEPT. OF LABOR & INDUSTRY
WA7110MAOtherREGENCE BLUE SHIELD
WA3455MAOtherREGENCE BLUE SHIELD
WA7574020OtherAETNA
WA8330979Medicaid
WA8934744OtherL&I CRIME VICTIMS
WAP00008119OtherRAILROAD MEDICARE
WA710883456-98501-A003OtherTRICARE
WA710883456-98512-A003OtherTRICARE
WA7574020OtherAETNA