Provider Demographics
NPI:1861187114
Name:JAMES, JAMES JOHN (PTA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:JOHN
Last Name:JAMES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N SPRIGG ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63701-4815
Mailing Address - Country:US
Mailing Address - Phone:573-335-5810
Mailing Address - Fax:573-334-0968
Practice Address - Street 1:717 N SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4815
Practice Address - Country:US
Practice Address - Phone:573-335-5810
Practice Address - Fax:573-334-0968
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160009788163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse