Healthcare Provider Details

I. General information

NPI: 1831211200
Provider Name (Legal Business Name): JAMES WESLEY MCLAIN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 BOCA CHICA BLVD
BROWNSVILLE TX
78520-8141
US

IV. Provider business mailing address

113 RICHARD ST
CORPUS CHRISTI TX
78415-4347
US

V. Phone/Fax

Practice location:
  • Phone: 956-544-2401
  • Fax:
Mailing address:
  • Phone: 361-881-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2035855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: