MEDICARE: JAMES DOUGLAS PT

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
1	225100000X	Physical Therapist	PT003001	WV

General Provider Information

NPI Number	:	1811440373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES DOUGLAS PT

Provider Business Mailing Address
First Line	:	501 FAIRMOUNT AVE
Second Line	:	STE 302
City	:	TOWSON
State	:	MD
Zip	:	21286-5457
Country	:	US
Telephone Number	:	410-927-8768
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 COWARDLY LION DR
Second Line	:	UNIT D
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6785
Country	:	US
Telephone Number	:	304-754-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	08/01/2016

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Directions to “ JAMES DOUGLAS PT” Practice Location

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