Provider Demographics
NPI:1154951473
Name:VOLK, JAMES DOUGLAS (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DOUGLAS
Last Name:VOLK
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 E SALTZ LN
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-7000
Mailing Address - Country:US
Mailing Address - Phone:253-951-4646
Mailing Address - Fax:
Practice Address - Street 1:1821 LECLERC RD N
Practice Address - Street 2:
Practice Address - City:CUSICK
Practice Address - State:WA
Practice Address - Zip Code:99119-5015
Practice Address - Country:US
Practice Address - Phone:509-447-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-26
Last Update Date:2020-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60043032225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant