Provider Demographics
NPI:1366194425
Name:JAMES, DALESIA ROSE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:DALESIA
Middle Name:ROSE
Last Name:JAMES
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2633 WILLOW OAK RD
Mailing Address - Street 2:
Mailing Address - City:GLADEWATER
Mailing Address - State:TX
Mailing Address - Zip Code:75647-3675
Mailing Address - Country:US
Mailing Address - Phone:409-679-5123
Mailing Address - Fax:
Practice Address - Street 1:850 BUFFALO ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2119
Practice Address - Country:US
Practice Address - Phone:903-841-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TX20000538772255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer