Provider Demographics
NPI:1740585108
Name:FORESMAN, JAMES LARRY JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LARRY
Last Name:FORESMAN
Suffix:JR
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 1:915 W BOND ST
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2101
Mailing Address - Country:US
Mailing Address - Phone:903-744-2862
Mailing Address - Fax:903-465-4515
Practice Address - Street 1:915 W BOND ST
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2101
Practice Address - Country:US
Practice Address - Phone:903-744-2862
Practice Address - Fax:903-465-4515
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2010088225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant