Provider Demographics
NPI:1316069255
Name:MASON, ALEXIS MULHEARN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:MULHEARN
Last Name:MASON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MRS
Other - First Name:ALEXIS
Other - Middle Name:MULHEARN
Other - Last Name:DANGLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:1826 7TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-7034
Mailing Address - Country:US
Mailing Address - Phone:772-794-1056
Mailing Address - Fax:
Practice Address - Street 1:2200 INDIAN CREEK BLVD W
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1331
Practice Address - Country:US
Practice Address - Phone:772-562-3534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19143225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant