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General NPI Number Information
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NPI Number | 1467441626
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Entity Type | Individual
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Provider Name | JAMES MICHAEL PREVOST EDD, SCAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 12/29/2021
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Provider Practice Location Address
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Address Line | 224 T R HARRIS DR
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City | SHELBY
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State | NC
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Zip | 28150-3487
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Country | US
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Telephone | 704-466-8820
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Fax |
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Provider Business Mailing Address
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Address Line | 224 T R HARRIS DR
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City | SHELBY
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State | NC
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Zip | 28150-3487
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Country | US
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Telephone | 704-466-8820
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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 | 2083S0010X
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Taxonomy Name | Sports Medicine (Preventive Medicine) Physician
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License Number | 2462
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 204C00000X
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Taxonomy Name | Sports Medicine (Neuromusculoskeletal Medicine) Physician
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License Number | 2462
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2462
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number | 2462
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 246ZX2200X
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Taxonomy Name | Orthopedic Assistant
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License Number | 2462
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License Number State | SC
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Taxonomy #6
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2462
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License Number State | SC
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