Provider Demographics
NPI:1689169443
Name:MOUTON, JAMES (PTA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:MOUTON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:586-541-3735
Practice Address - Street 1:4967 CROOKS RD STE 150
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48098-5802
Practice Address - Country:US
Practice Address - Phone:248-509-9700
Practice Address - Fax:248-509-9701
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5502004797225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant