Provider Demographics
NPI:1386257426
Name:BINION, JIMMY DALE JR (LMT)
Entity type:Individual
Prefix:MR
First Name:JIMMY
Middle Name:DALE
Last Name:BINION
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5456 FOXWOOD DR NE
Mailing Address - Street 2:
Mailing Address - City:RIEGELWOOD
Mailing Address - State:NC
Mailing Address - Zip Code:28456-9303
Mailing Address - Country:US
Mailing Address - Phone:910-742-5096
Mailing Address - Fax:
Practice Address - Street 1:5456 FOXWOOD DR NE
Practice Address - Street 2:
Practice Address - City:RIEGELWOOD
Practice Address - State:NC
Practice Address - Zip Code:28456-9303
Practice Address - Country:US
Practice Address - Phone:910-742-5096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13079225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty