Provider Demographics
NPI:1053576975
Name:MASON, ERIC D (PT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:D
Last Name:MASON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 BEACHWOOD CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5706
Mailing Address - Country:US
Mailing Address - Phone:904-996-6922
Mailing Address - Fax:904-996-6923
Practice Address - Street 1:3500 BEACHWOOD CT
Practice Address - Street 2:SUITE 203
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5706
Practice Address - Country:US
Practice Address - Phone:904-996-6922
Practice Address - Fax:904-996-6923
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0010346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist