Provider Demographics
NPI:1891943528
Name:PRATT, JAMES JONATHAN (MS, ATC, OTC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JONATHAN
Last Name:PRATT
Suffix:
Gender:M
Credentials:MS, ATC, OTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06762-1720
Mailing Address - Country:US
Mailing Address - Phone:203-509-9051
Mailing Address - Fax:
Practice Address - Street 1:1139 3RD ST
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-3465
Practice Address - Country:US
Practice Address - Phone:530-541-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-06
Last Update Date:2008-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0014922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer