1770980237 NPI number — DAVIS PHYSICAL THERAPY P.A.

Table of content: (NPI 1770980237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770980237 NPI number — DAVIS PHYSICAL THERAPY P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS PHYSICAL THERAPY P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1770980237
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
227 TADCASTER CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOHNS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32259-7256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-287-9969
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7685 103RD ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210-9325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-771-1116
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2014

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
904-287-9969

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT25261 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1992771851 . This is a "NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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