Provider Demographics
NPI:1487118642
Name:SAVAGE, MASON (LPTA)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 BAYFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-3552
Mailing Address - Country:US
Mailing Address - Phone:940-218-0853
Mailing Address - Fax:
Practice Address - Street 1:201 E THOMPSON ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:TX
Practice Address - Zip Code:76234-2736
Practice Address - Country:US
Practice Address - Phone:940-627-2165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-22
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2136033225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant