Mason Keith Roach

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA 20936 Issued in FL

Practice address

2762 Dora Ave
Tavares, FL 32778-4970

Phone

(352) 742-7837

Fax

(352) 742-7837

NPI assigned

Jul 10, 2009

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1247184000000",
    "number": "1568691616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37015 RANCH RD",
            "city": "EUSTIS",
            "state": "FL",
            "postal_code": "327368413",
            "telephone_number": "352-455-7493",
            "fax_number": "352-742-7837"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2762 DORA AVE",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327784970",
            "telephone_number": "352-742-7837",
            "fax_number": "352-742-7837"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROACH",
        "first_name": "MASON",
        "middle_name": "KEITH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-07-10",
        "last_updated": "2009-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA 20936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carine B Richard, CNM
• Rise Home Support Services LLC
• Joseph A Risko, DO
• Alba Damaris Rivera-Diaz, MD, LND
• RK Medical PA
• Terrance Roberson
• Robert W Ladley D.M.D. PA
• Jodi Robison, MS, RD, LD/N
• Amanda Marina Rodriguez
• Ronald Franciso Rodriquez

• Physical Therapy Assistant in Tavares, FL
• Providers in Tavares, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2009; 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.