Provider Demographics
NPI:1497973945
Name:MALE, JAMES DONALD (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DONALD
Last Name:MALE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14213-7603
Mailing Address - Country:US
Mailing Address - Phone:716-517-5043
Mailing Address - Fax:
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3118
Practice Address - Country:US
Practice Address - Phone:866-416-5202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000918225200000X
NY005467225200000X
SC2037225200000X
NCA3382225200000X
VA2306602097225200000X
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant