Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225200000X | Physical Therapy Assistant | 2099726 | TX |
Y | 225200000X | Physical Therapy Assistant | PTA5112 | MS |
NPI | 1003244104 |
---|---|
Provider Name | James Scott II |
First Address | Lucedale, MS 39452-5659 |
Second Address | Lucedale, MS 39452-5659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2013 |
Last Update Date | 29/10/2013 |