Provider Demographics
NPI:1417250069
Name:DAVIS, SETH R (PT)
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7643 LAKE RAYSTOWN SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:16652-8403
Mailing Address - Country:US
Mailing Address - Phone:814-643-2476
Mailing Address - Fax:814-643-6775
Practice Address - Street 1:7643 LAKE RAYSTOWN SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:16652-8403
Practice Address - Country:US
Practice Address - Phone:814-643-2476
Practice Address - Fax:814-643-6775
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT020655225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist