Provider Demographics
NPI:1558624031
Name:DAVIDSON JONES, AMANDA (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:DAVIDSON JONES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:445 CHICKAMAUGA DR
Mailing Address - Street 2:STE 101
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-4222
Mailing Address - Country:US
Mailing Address - Phone:440-209-1836
Mailing Address - Fax:
Practice Address - Street 1:50 NORMANDY DR
Practice Address - Street 2:
Practice Address - City:PAINESVILLE
Practice Address - State:OH
Practice Address - Zip Code:44077-1600
Practice Address - Country:US
Practice Address - Phone:440-639-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH013690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0747777Medicaid
OH0747777Medicaid