Individual
MRS. LARINA SMITH MASON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
2222 S FRONTAGE RD, SUITE D, VICKSBURG, MS 39180-5271
(601) 456-0159
Mailing address
2116 N CHAPEL HILL RD, RAYMOND, MS 39154-8064
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 3041
MS
Other
Enumeration date
10/15/2012
Last updated
10/15/2012
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