Provider Demographics
NPI:1053638478
Name:MASTBROOK, PAULA TOWSON (CMT)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:TOWSON
Last Name:MASTBROOK
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11250 ROGER BACON DR STE 23
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5202
Mailing Address - Country:US
Mailing Address - Phone:703-858-0334
Mailing Address - Fax:
Practice Address - Street 1:11250 ROGER BACON DR STE 23
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5202
Practice Address - Country:US
Practice Address - Phone:703-858-0334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-25
Last Update Date:2010-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAM10-305174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist