Healthcare Provider Details

I. General information

NPI: 1760955793
Provider Name (Legal Business Name): JAMES ANDREW SLACK DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST STE 601
SALISBURY MD
21804-6938
US

IV. Provider business mailing address

659 S SALISBURY BLVD STE 1B
SALISBURY MD
21801-5458
US

V. Phone/Fax

Practice location:
  • Phone: 410-548-7600
  • Fax:
Mailing address:
  • Phone: 410-831-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27310
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: