Provider Demographics
NPI:1255863288
Name:AUTRY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:AUTRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4029 TARPON SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-3416
Mailing Address - Country:US
Mailing Address - Phone:850-361-9837
Mailing Address - Fax:
Practice Address - Street 1:4029 TARPON SPRINGS DR
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76123-3416
Practice Address - Country:US
Practice Address - Phone:850-361-9837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer