Healthcare Provider Details

I. General information

NPI: 1699053306
Provider Name (Legal Business Name): JAMES WILLIAM BEDWELL DPT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 09/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 E KING ST
SEAFORD DE
19973-3505
US

IV. Provider business mailing address

1011 RUSSELL AVE
SALISBURY MD
21801-6151
US

V. Phone/Fax

Practice location:
  • Phone: 302-628-3000
  • Fax:
Mailing address:
  • Phone: 410-708-4986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25798
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: