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Organization
GORDON DAVID MASON AND EMILY SUE MASON
Active
Organization
GORDON DAVID MASON AND EMILY SUE MASON
Active
Other names
Mason Physical Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GORDON DAVID MASON (OWNER / ADMINISTRATOR)
(951) 682-4176
Entity
Organization
Contact information
Practice address
6840 INDIANA AVE, SUITE 130, RIVERSIDE, CA 92506-4298
(951) 682-4176
(951) 682-4188
Mailing address
6840 INDIANA AVE, SUITE 130, RIVERSIDE, CA 92506-4298
(951) 682-4176
(951) 682-4188
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ66551Z
BLUE SHIELD
CA
Enumeration date
06/23/2006
Last updated
08/22/2020
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