Provider Demographics
NPI:1679718761
Name:GIAMBRONE, JAMES JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:
Last Name:GIAMBRONE
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1824
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411-1824
Mailing Address - Country:US
Mailing Address - Phone:541-347-1236
Mailing Address - Fax:
Practice Address - Street 1:1210 SANDPIPER LN SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-8819
Practice Address - Country:US
Practice Address - Phone:541-347-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13723225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR13723OtherSTATE MASSAGE LICENSE