Provider Demographics
NPI:1194938043
Name:JAMES, SHIRLEY JULIANNA (PTA)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JULIANNA
Last Name:JAMES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11220 SE 73RD COURT
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-4217
Mailing Address - Country:US
Mailing Address - Phone:352-245-2085
Mailing Address - Fax:
Practice Address - Street 1:600 N BLVD WEST
Practice Address - Street 2:SUIT D
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5063
Practice Address - Country:US
Practice Address - Phone:352-787-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18665225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant