1356824452 NPI number — DR. ALEX JAMES FELLER DAVIES PT, DPT, CSCS

Table of content: DR. ALEX JAMES FELLER DAVIES PT, DPT, CSCS (NPI 1356824452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356824452 NPI number — DR. ALEX JAMES FELLER DAVIES PT, DPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIES
Provider First Name:
ALEX
Provider Middle Name:
JAMES FELLER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356824452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2607 WALNUT LOOP NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLYMPIA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98502-4417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-791-0989
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14802 N DEL WEBB BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUN CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85351-2146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-977-2775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30294 . This is a "ARIZONA PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0015846 . This is a "COLORADO PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 60918764 . This is a "WASHINGTON STATE PHYSICAL THERAPY LICENSE" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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