Provider Demographics
NPI:1285682765
Name:DAVIS, SANDRA (PT)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4425A PAULSEN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3637
Mailing Address - Country:US
Mailing Address - Phone:912-354-5100
Mailing Address - Fax:912-354-5300
Practice Address - Street 1:4425A PAULSEN ST FL 2
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-3637
Practice Address - Country:US
Practice Address - Phone:912-354-5100
Practice Address - Fax:912-354-5300
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006279225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA238145789AMedicaid
GA238145789AMedicaid
GA65BBCRLMedicare ID - Type Unspecified