Provider Demographics
NPI:1508027327
Name:DAVIS, DUANE (RPT)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2029 W LAWSON ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-1322
Mailing Address - Country:US
Mailing Address - Phone:479-521-3553
Mailing Address - Fax:
Practice Address - Street 1:6440 MILLROCK DR
Practice Address - Street 2:SUITE 175
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-5589
Practice Address - Country:US
Practice Address - Phone:800-676-3490
Practice Address - Fax:866-588-1518
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist