Provider Demographics
NPI:1073703203
Name:DAVIS, PHILLIP LAWRENCE (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:LAWRENCE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 41465
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0025
Mailing Address - Country:US
Mailing Address - Phone:512-442-3200
Mailing Address - Fax:512-442-3206
Practice Address - Street 1:611 S CONGRESS AVE
Practice Address - Street 2:STE 205
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1729
Practice Address - Country:US
Practice Address - Phone:512-442-3200
Practice Address - Fax:512-442-3206
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1174498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist