Provider Demographics
NPI:1578756375
Name:DAVIS, JESSICA ERIN CARLTON (PT)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ERIN CARLTON
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ATRIUM WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6301
Mailing Address - Country:US
Mailing Address - Phone:803-788-8484
Mailing Address - Fax:803-788-8499
Practice Address - Street 1:3040 HIGHWAY 17 BYP N STE A
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-9438
Practice Address - Country:US
Practice Address - Phone:843-388-7667
Practice Address - Fax:843-388-7877
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5553225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC42-6594OtherMEDICARE PROVIDER NUMBER
SCGP1708Medicaid
SCTH1832Medicaid