Provider Demographics
NPI:1942886007
Name:BASHAM, JAMES SCOTT (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SCOTT
Last Name:BASHAM
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 FORT WRIGHT OVAL
Mailing Address - Street 2:
Mailing Address - City:FAIRCHILD AFB
Mailing Address - State:WA
Mailing Address - Zip Code:99011-2203
Mailing Address - Country:US
Mailing Address - Phone:210-488-4424
Mailing Address - Fax:
Practice Address - Street 1:731 N STANLEY ST
Practice Address - Street 2:
Practice Address - City:MEDICAL LAKE
Practice Address - State:WA
Practice Address - Zip Code:99022-8940
Practice Address - Country:US
Practice Address - Phone:509-299-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61121148225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist