Provider Demographics
NPI:1114941101
Name:DAVIS, ROGER A II (PT, DPT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:A
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6397 LEE HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4915
Mailing Address - Country:US
Mailing Address - Phone:423-238-8930
Mailing Address - Fax:423-254-5217
Practice Address - Street 1:2420 LIME KILN LN STE C
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3425
Practice Address - Country:US
Practice Address - Phone:502-630-3296
Practice Address - Fax:502-630-3302
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY186592Medicare UPIN