Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA22747 | FL |
NPI | 1003321472 |
---|---|
Provider Name | Clifton Mason |
First Address | Lake Mary, FL 32746-5219 |
Second Address | Lake Mary, FL 32746-5219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |