Provider Demographics
NPI:1871076448
Name:STABILE, JAMES NICHOLAS (PTA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:NICHOLAS
Last Name:STABILE
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 1:601 ORCHARD HILLS DR UNIT 7008
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:IA
Mailing Address - Zip Code:50211-9405
Mailing Address - Country:US
Mailing Address - Phone:319-210-7238
Mailing Address - Fax:
Practice Address - Street 1:6901 PECKHAM ST
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:IA
Practice Address - Zip Code:50131-3143
Practice Address - Country:US
Practice Address - Phone:515-253-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092265225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant