Provider Demographics
NPI:1285223479
Name:ALLIE, JAMES (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ALLIE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:GEORGE
Other - Last Name:ALLIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 949
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0949
Mailing Address - Country:US
Mailing Address - Phone:706-857-6366
Mailing Address - Fax:706-857-6372
Practice Address - Street 1:11638 HIGHWAY 27 STE 1
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:GA
Practice Address - Zip Code:30747-8515
Practice Address - Country:US
Practice Address - Phone:706-857-6366
Practice Address - Fax:706-857-6372
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT014466225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist