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NPI Code Detail

MEDICARE: JAMES MOUTON PTA

MEDICARE: JAMES MOUTON PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant5502004797MI

General Provider Information

NPI Number : 1689169443
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMES MOUTON PTA
Provider Business Mailing Address
First Line : 33900 HARPER AVE STE 104
Second Line :
City : CLINTON TWP
State : MI
Zip : 48035-4258
Country : US
Telephone Number : 586-350-2644
Fax Number : 586-541-3735
Provider Business Practice Location Address
First Line : 4967 CROOKS RD STE 150
Second Line :
City : TROY
State : MI
Zip : 48098-5802
Country : US
Telephone Number : 248-509-9700
Fax Number : 248-509-9701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2018
Last Update Date : 12/26/2023

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