Healthcare Provider Details

I. General information

NPI: 1043669401
Provider Name (Legal Business Name): JAMES EDWARD FIFE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 W CENTRAL AVE STE B
EL DORADO KS
67042-3465
US

IV. Provider business mailing address

321 S 3RD ST STE B
DANVILLE KY
40422-2090
US

V. Phone/Fax

Practice location:
  • Phone: 316-452-5033
  • Fax: 316-452-5053
Mailing address:
  • Phone: 859-236-7012
  • Fax: 859-236-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012409
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1359583
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11-07119
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP017183T
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: