Individual
MASON KEITH ROACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2762 DORA AVE, TAVARES, FL 32778-4970
(352) 742-7837
(352) 742-7837
Mailing address
37015 RANCH RD, EUSTIS, FL 32736-8413
(352) 455-7493
(352) 742-7837
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA 20936
FL
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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