Provider Demographics
NPI:1902562325
Name:FETTER, JAMES CHRISTOPHER (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:CHRISTOPHER
Last Name:FETTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:FL
Mailing Address - Zip Code:32141-7273
Mailing Address - Country:US
Mailing Address - Phone:631-672-4259
Mailing Address - Fax:
Practice Address - Street 1:5535 S WILLIAMSON BLVD # 705
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128-8311
Practice Address - Country:US
Practice Address - Phone:386-231-6327
Practice Address - Fax:386-767-7281
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist