Individual provider Active NPI

Mary Elaine Mason, PTA

  • Physical Therapy Assistant
  • Freeport, FL
National Provider Identifier
1417807017
Registry record updated Feb 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA33172 Issued in FL
Practice address
310 Gray Owl Dr W
Freeport, FL 32439-0408
Phone
(850) 622-0842
NPI assigned
Feb 2, 2026
Last updated
Feb 2, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA33172 FL Primary

Addresses

Primary practice location

310 Gray Owl Dr W
Freeport, FL 32439-0408

Mailing address

310 Gray Owl Dr W
Freeport, FL 32439-0408
Phone (850) 622-0842

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA33172FLMDPhysical Therapy Assistant

NPI Registry JSON

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

{
    "created_epoch": "1769990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769990400000",
    "number": "1417807017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 GRAY OWL DR W",
            "city": "FREEPORT",
            "state": "FL",
            "postal_code": "324390408",
            "telephone_number": "850-622-0842"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 GRAY OWL DR W",
            "city": "FREEPORT",
            "state": "FL",
            "postal_code": "324390408",
            "telephone_number": "850-622-0842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASON",
        "first_name": "MARY",
        "middle_name": "ELAINE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-02-02",
        "last_updated": "2026-02-02",
        "certification_date": "2026-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA33172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Freeport, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.