Provider Demographics
NPI:1407579279
Name:STONE, JAMES EDWARD (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:STONE
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12356 BALLPARK WAY
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-4817
Mailing Address - Country:US
Mailing Address - Phone:816-721-9205
Mailing Address - Fax:
Practice Address - Street 1:12356 BALLPARK WAY
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-4817
Practice Address - Country:US
Practice Address - Phone:816-721-9205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1204020812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer