Basic Information
| Provider Information | |||||||||
| NPI: | 1417923137 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NETTLES | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6767 OLD MADISON PIKE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358062172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569226650 | ||||||||
| FaxNumber: | 2569226651 | ||||||||
| Practice Location | |||||||||
| Address1: | 6767 OLD MADISON PIKE | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358062172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2569226650 | ||||||||
| FaxNumber: | 2569226651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/23/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH4152 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 51528524 | 01 | AL | BCBS | OTHER |