Provider Demographics
NPI:1841189735
Name:SNODGRASS, MASON (PT)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:SNODGRASS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MONROE AVE NE APT G12
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-8489
Mailing Address - Country:US
Mailing Address - Phone:707-799-8120
Mailing Address - Fax:
Practice Address - Street 1:2737 77TH AVE SE STE 214
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2832
Practice Address - Country:US
Practice Address - Phone:206-518-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT.PT.700076892251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports