Provider Demographics
NPI:1477585578
Name:FENT, JAMES ANDREW (PT, MS)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANDREW
Last Name:FENT
Suffix:
Gender:M
Credentials:PT, MS
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Mailing Address - Street 1:38860 SKY CANYON DR
Mailing Address - Street 2:BLDG B
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2540
Mailing Address - Country:US
Mailing Address - Phone:951-304-1100
Mailing Address - Fax:951-304-1135
Practice Address - Street 1:38860 SKY CANYON DR
Practice Address - Street 2:BLDG B
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-2540
Practice Address - Country:US
Practice Address - Phone:951-304-1100
Practice Address - Fax:951-304-1135
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14052225100000X
CAMFC 46173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT140521Medicare PIN