Active NPI
Derrick Mason Jr., RKT
- Kinesiotherapist
- San Antonio, TX
National Provider Identifier
1669807400
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Kinesiotherapist
- License
- 1906
- Practice address
- 7400 Merton Minter St
San Antonio, TX 78229-4404 - Phone
- (210) 617-5300
- NPI assigned
- Sep 12, 2013
- Last updated
- Sep 12, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Kinesiotherapist | 226300000X | 1906 | MS | Primary |
Addresses
Primary practice location
7400 Merton Minter St
San Antonio, TX 78229-4404
Mailing address
200 Blue Gable Rd
Apt. 410
Hattiesburg, MS 39401-3004
Phone (601) 896-1983
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
| License | State | Type | Specialty |
|---|---|---|---|
| 1906 | MS | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1669807400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 BLUE GABLE RD",
"address_2": "APT. 410",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "394013004",
"telephone_number": "601-896-1983"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7400 MERTON MINTER ST",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782294404",
"telephone_number": "210-617-5300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MASON",
"first_name": "DERRICK",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "RKT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-12",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "226300000X",
"taxonomy_group": "",
"desc": "Kinesiotherapist",
"state": "MS",
"license": "1906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.