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General NPI Number Information
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NPI Number | 1013722602
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Entity Type | Individual
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Provider Name | JAMES LOUIS ROUNDTREE III LAT, ATC, MBA
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Gender | Male
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 2419 STATE AVE
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City | CORAOPOLIS
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State | PA
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Zip | 15108-2233
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Country | US
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Telephone | 724-980-4233
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Fax |
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Provider Business Mailing Address
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Address Line | 334 ACADEMY ST
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City | CARNEGIE
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State | PA
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Zip | 15106-2782
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Country | US
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Telephone | 724-980-4233
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | RT007029
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License Number State | PA
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