Provider Demographics
NPI:1477833432
Name:PIERRE-GLAUDE, JAMES KEVIN (DPT,ATC,CSCS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:PIERRE-GLAUDE
Suffix:
Gender:M
Credentials:DPT,ATC,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 MIDDLE COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-3362
Mailing Address - Country:US
Mailing Address - Phone:631-732-3900
Mailing Address - Fax:
Practice Address - Street 1:607 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-3362
Practice Address - Country:US
Practice Address - Phone:631-732-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist