Provider Demographics
NPI:1043669401
Name:FIFE, JAMES EDWARD (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:FIFE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 S 3RD ST STE B
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2090
Mailing Address - Country:US
Mailing Address - Phone:859-236-7012
Mailing Address - Fax:859-236-7407
Practice Address - Street 1:2348 W CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-3465
Practice Address - Country:US
Practice Address - Phone:316-452-5033
Practice Address - Fax:316-452-5053
Is Sole Proprietor?:No
Enumeration Date:2016-06-07
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012409225100000X
TX1359583225100000X
KS11-07119225100000X
KYCP017183T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist