Healthcare Provider Details

I. General information

NPI: 1720073687
Provider Name (Legal Business Name): JAMES A DAUBER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S TWINING STREET
MAXWELL AFB AL
36112-6219
US

IV. Provider business mailing address

110 ABERDEEN CT
PRATTVILLE AL
36066-7252
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-5867
  • Fax: 334-953-9158
Mailing address:
  • Phone: 334-361-8916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT-008404-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: