Provider Demographics
NPI:1861502742
Name:DATTILO, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:DATTILO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 TALL SHIPS DR
Mailing Address - Street 2:
Mailing Address - City:FRIENDSWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77546-2306
Mailing Address - Country:US
Mailing Address - Phone:281-996-8680
Mailing Address - Fax:
Practice Address - Street 1:3800 SPENCER HWY STE F
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1250
Practice Address - Country:US
Practice Address - Phone:713-943-8573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2042984OtherLICENSE #