Provider Demographics
NPI:1184221319
Name:DAVIS, WILL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:WILL
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:CHANTLER
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:966 N GARDEN RIDGE BLVD STE 530
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2876
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:844-965-9627
Practice Address - Street 1:5501 GORDON SMITH DR STE 100
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75089-3210
Practice Address - Country:US
Practice Address - Phone:972-475-5122
Practice Address - Fax:833-231-7606
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1334604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist