Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1173630 | TX |
Y | 225100000X | Physical Therapist | CP004769T | NC |
N | 226300000X | Kinesiotherapist |
NPI | 1003926676 |
---|---|
Provider Name | James Edward Fenton |
First Address | Morehead City, NC 28557-3184 |
Second Address | Morehead City, NC 28557-3184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 13/04/2021 |