Provider Demographics
NPI:1427025089
Name:DAVIS, JENNIFER M (DPT, OCS)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36533-1212
Mailing Address - Country:US
Mailing Address - Phone:251-928-4033
Mailing Address - Fax:251-928-4032
Practice Address - Street 1:912 PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-2952
Practice Address - Country:US
Practice Address - Phone:251-928-4033
Practice Address - Fax:251-928-4032
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH31082251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51094156OtherBCBS OF AL
ALDA890005550Medicaid
AL510I650138Medicare PIN