Provider Demographics
NPI:1588553275
Name:SWIMMER, MASON AUGUST (MT-BC)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:AUGUST
Last Name:SWIMMER
Suffix:
Gender:M
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MEADOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-1307
Mailing Address - Country:US
Mailing Address - Phone:704-996-0381
Mailing Address - Fax:
Practice Address - Street 1:1319 LOMAX AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-2546
Practice Address - Country:US
Practice Address - Phone:704-996-0381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist