Healthcare Provider Details

I. General information

NPI: 1235105156
Provider Name (Legal Business Name): JAMES MACDONALD P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16717 US HIGHWAY 17 N SUITE 206
HAMPSTEAD NC
28443-3088
US

IV. Provider business mailing address

PO BOX 2722 9 SHELL COURT
SURF CITY NC
28445-9821
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-2070
  • Fax: 910-270-4020
Mailing address:
  • Phone: 910-328-6087
  • Fax: 910-270-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5782
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: