Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1293827 | TX |
NPI | 1437677028 |
---|---|
Provider Name | Dr. Mason Thomas Mcdonald |
First Address | Tampa, FL 33612-4739 |
Second Address | Tampa, FL 33612-4745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2017 |
Last Update Date | 02/09/2017 |