Provider Demographics
NPI:1689738247
Name:MAYS, JAMES THOMAS II (MS ED, ATC)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:THOMAS
Last Name:MAYS
Suffix:II
Gender:M
Credentials:MS ED, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5348
Mailing Address - Country:US
Mailing Address - Phone:618-462-1471
Mailing Address - Fax:
Practice Address - Street 1:SOUTHERN ILLINOIS UNIVERSITY -EDWARDSVILLE
Practice Address - Street 2:ATHLETICS, BOX 1129
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62026-1129
Practice Address - Country:US
Practice Address - Phone:618-650-2160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL08062276OtherNATA BOC CERTIFICATION #