Healthcare Provider Details

I. General information

NPI: 1245464585
Provider Name (Legal Business Name): MARK S. JAMES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E WINDMILL LN # 1B-193
LAS VEGAS NV
89123-1869
US

IV. Provider business mailing address

505 E WINDMILL LN # 1B-193
LAS VEGAS NV
89123-1869
US

V. Phone/Fax

Practice location:
  • Phone: 702-401-4017
  • Fax:
Mailing address:
  • Phone: 702-401-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP-774
License Number StateNV

VIII. Authorized Official

Name: MARK S JAMES
Title or Position: PRESIDENT SPEECH LANGUAGE PATHOLOGI
Credential: MS, CCC-SLP
Phone: 702-401-4017