Provider Demographics
NPI:1346407459
Name:PARADO, JAMES (RPT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:PARADO
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 SISTER MARTIN DR
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-7068
Mailing Address - Country:US
Mailing Address - Phone:765-868-2203
Mailing Address - Fax:765-868-8312
Practice Address - Street 1:517 SISTER MARTIN DR
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-7068
Practice Address - Country:US
Practice Address - Phone:765-868-2203
Practice Address - Fax:765-868-8312
Is Sole Proprietor?:No
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007855A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200686410Medicaid