Provider Demographics
NPI:1639162035
Name:MURDOCK, JAMES WILLIAM (ATC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:MURDOCK
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SEBRING RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7836
Mailing Address - Country:US
Mailing Address - Phone:802-864-3819
Mailing Address - Fax:
Practice Address - Street 1:97 SPEAR ST
Practice Address - Street 2:140 PARTICK
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05405-1701
Practice Address - Country:US
Practice Address - Phone:802-656-9574
Practice Address - Fax:802-656-9578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT104-00000162255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer