Provider Demographics
NPI:1205001344
Name:WADDLE, JAMES GILBERT III (LPTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GILBERT
Last Name:WADDLE
Suffix:III
Gender:M
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 NC HIGHWAY 39 N
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:27549-8329
Mailing Address - Country:US
Mailing Address - Phone:919-496-7323
Mailing Address - Fax:
Practice Address - Street 1:1704 NC HIGHWAY 39 N
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-8329
Practice Address - Country:US
Practice Address - Phone:919-496-7323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2906225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant