Provider Demographics
NPI:1588555205
Name:MASON, TEDDY O
Entity type:Individual
Prefix:
First Name:TEDDY
Middle Name:O
Last Name:MASON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 CLIFFDALE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-5804
Mailing Address - Country:US
Mailing Address - Phone:919-931-3505
Mailing Address - Fax:
Practice Address - Street 1:8134 CLIFFDALE RD STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-5804
Practice Address - Country:US
Practice Address - Phone:919-931-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC84781225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner