Individual
MS. ELLISSA LAUREN MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3131 TOM AUSTIN HWY, SPRINGFIELD, TN 37172-4801
(615) 382-7979
Mailing address
133 HIGHWAY 321, BEEBE, AR 72012-9726
(501) 203-7966
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
4350
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4350
PHYSICAL THERAPIST ASSISTANT
AR
Enumeration date
10/03/2018
Last updated
10/03/2018
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