Provider Demographics
NPI:1265910251
Name:JAMES, J.DYLAN (DPT)
Entity type:Individual
Prefix:
First Name:J.DYLAN
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:PO BOX 445
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0445
Mailing Address - Country:US
Mailing Address - Phone:270-274-9221
Mailing Address - Fax:270-955-2003
Practice Address - Street 1:227 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-2131
Practice Address - Country:US
Practice Address - Phone:270-274-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY007425225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY007425OtherKENTUCKY BOARD OF PHYSICAL THERAPY LICENSE NUMBER