Provider Demographics
NPI:1629015425
Name:DAVIS AND WATSON PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:DAVIS AND WATSON PHYSICAL THERAPY INC.
Other - Org Name:SANTA ANA TUSTIN PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/PT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNY
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:714-835-6638
Mailing Address - Street 1:1910 OLD TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-7811
Mailing Address - Country:US
Mailing Address - Phone:714-835-6638
Mailing Address - Fax:714-835-4889
Practice Address - Street 1:1910 OLD TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7811
Practice Address - Country:US
Practice Address - Phone:714-835-6638
Practice Address - Fax:714-835-4889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192422251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14458Medicare ID - Type Unspecified