Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 8327 | SC |
N | 2251G0304X | Physical Therapist - Geriatrics | PT016508 | OH |
NPI | 1285181941 |
---|---|
Provider Name | Dr. Tara Lynn Mast |
First Address | Mount Pleasant, SC 29464-3957 |
Second Address | Mount Pleasant, SC 29464 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2016 |
Last Update Date | 20/11/2018 |