Provider Demographics
NPI:1932191277
Name:GEORGE, JAMES R (PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:R
Last Name:GEORGE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10609 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-2009
Mailing Address - Country:US
Mailing Address - Phone:818-361-9499
Mailing Address - Fax:818-365-2252
Practice Address - Street 1:10609 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2009
Practice Address - Country:US
Practice Address - Phone:818-361-9499
Practice Address - Fax:818-365-2252
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT20129Medicare UPIN