Mason Shaw, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT10908 Issued in LA

Practice address

309 S Washington St
Deridder, LA 70634-4861

Phone

(337) 462-6097

Fax

(337) 462-0531

NPI assigned

Jun 25, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Beauregard Physical Therapy Clinic, IncGroup PAC ID 6002967684, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Beauregard Physical Therapy Clinic, Inc

  • Physical Therapist
  • Deridder, LA
  • NPI 1003080367
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1245800051",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S WASHINGTON ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344861",
            "telephone_number": "337-462-6097",
            "fax_number": "337-462-0531"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S WASHINGTON ST",
            "city": "DERIDDER",
            "state": "LA",
            "postal_code": "706344861",
            "telephone_number": "337-462-6097",
            "fax_number": "337-462-0531"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "MASON",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-25",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "PT10908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert C Rushford, CRNA
• Jocelyn Salinas
• Connie Sanderlin, CRNA
• Marta Lichtl Schexnayder, MCD-CCC/SLP
• Serenity Child and Youth Counseling, LLC
• James T Shirley, D.D.S.
• Thomas Herbert Shirley, DDS
• Lacy Jaye Simmons, FNP
• Nada Singer, MS,CCC-SLP
• Nicholas Skinner

• Physical Therapist in Deridder, LA
• Providers in Deridder, LA by specialty
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.