Provider Demographics
NPI:1558739607
Name:DAVIS PHYSICAL THERAPY LLC
Entity Type:Organization
Organization Name:DAVIS PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CHT
Authorized Official - Phone:928-284-4755
Mailing Address - Street 1:31 BELL ROCK PLZ STE B
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86351-9099
Mailing Address - Country:US
Mailing Address - Phone:928-284-4755
Mailing Address - Fax:928-284-4756
Practice Address - Street 1:31 BELL ROCK PLZ STE B
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-9099
Practice Address - Country:US
Practice Address - Phone:928-284-4755
Practice Address - Fax:928-284-4756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-07
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6130261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy