Provider Demographics
NPI:1679820963
Name:REED, JAMES R (PT)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:REED
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 REPUBLIC AVE
Mailing Address - Street 2:APT 2101
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6993
Mailing Address - Country:US
Mailing Address - Phone:337-504-2788
Mailing Address - Fax:
Practice Address - Street 1:215 REPUBLIC AVE
Practice Address - Street 2:APT 2101
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6993
Practice Address - Country:US
Practice Address - Phone:337-504-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPT00762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist