Look up the most recent NPI and PECOS records

Mason Connor Mcmanimon-Myers

Physical Therapist

Respiratory, Developmental, Rehabilitative and Restorative Service Providers

1836 South Ave, La Crosse, WI 54601-5429

PECOS Enrollment

Based on the most recent information from CMS, provider Mason Connor Mcmanimon-Myers does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 12:57 PM.

Profile Details

Provider ID
1508336405
Provider Type
Individual
Full Name
Mcmanimon-Myers, Mason Connor
Credential
PT, DPT, ATC

Gender
Male
Sole Proprietor
Yes
Enumeration Date
12/4/2018
Last Updated
5/2/2024

Contact Information

Practice Location

1836 South Ave, La Crosse, WI 54601-5429

(608) 782-7300

Unlisted Fax

Mailing Location

1836 South Ave, La Crosse, WI 54601-5429

(608) 782-7300

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 225100000X Primary	Description Physical Therapist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 15888-24 Wisconsin
Code 390200000X	Description Student in an Organized Health Care Education/Training Program Student, Health Care	License Unlisted Issuer
Code 2255A2300X	Description Specialist/Technologist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License 2305 Wisconsin
Code 2255A2300X	Description Specialist/Technologist Respiratory, Developmental, Rehabilitative and Restorative Service Providers	License Unlisted Issuer

Mason Connor Mcmanimon-Myers

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Code

Description

License

Dettwiler, Kirsten L.

Davies, George J

Watkins, Douglas W

Miller, Jacob David

Laschenski, Kaylee Anne

Reznichek, Daniel A

Ehlenfeldt, Joyce R

Hendrickson, Stephanie A

Jenson, Bryce Daniel

Beekman, Joyce Evelyn