Provider Demographics
NPI:1447202015
Name:DAVIS, JENNIFER (MSPT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSPT
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 1119
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02901-1119
Mailing Address - Country:US
Mailing Address - Phone:401-330-1428
Mailing Address - Fax:401-626-3851
Practice Address - Street 1:100 BUTLER DR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4862
Practice Address - Country:US
Practice Address - Phone:401-330-1428
Practice Address - Fax:401-626-3851
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01657225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI409035OtherBLUECHIP RI IND. ID #