Provider Demographics
NPI:1235105156
Name:MACDONALD, JAMES (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2722
Mailing Address - Street 2:9 SHELL COURT
Mailing Address - City:SURF CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28445-9821
Mailing Address - Country:US
Mailing Address - Phone:910-328-6087
Mailing Address - Fax:910-270-4020
Practice Address - Street 1:16717 US HIGHWAY 17 N
Practice Address - Street 2:SUITE 206
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-3088
Practice Address - Country:US
Practice Address - Phone:910-270-2070
Practice Address - Fax:910-270-4020
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5782225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist