Basic Information
| Provider Information | |||||||||
| NPI: | 1912387960 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIST | ||||||||
| FirstName: | MASON | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 LONG PRAIRIE RD | ||||||||
| Address2: | 104 | ||||||||
| City: | FLOWER MOUND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750224217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727242400 | ||||||||
| FaxNumber: | 9727242495 | ||||||||
| Practice Location | |||||||||
| Address1: | 3001 FM 2181 | ||||||||
| Address2: | 150 | ||||||||
| City: | CORINTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762102101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9404984004 | ||||||||
| FaxNumber: | 9404984008 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2015 | ||||||||
| LastUpdateDate: | 06/05/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1259809 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.