Provider Demographics
NPI:1013472828
Name:JAMES, CALVIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:
Last Name:JAMES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 MALABAR RD NE STE 1
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3262
Mailing Address - Country:US
Mailing Address - Phone:321-409-5777
Mailing Address - Fax:
Practice Address - Street 1:1155 MALABAR RD NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3245
Practice Address - Country:US
Practice Address - Phone:321-409-5777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL185503544058OtherAMERICAN HEART ASSOCIATION