Provider Demographics
NPI:1629318050
Name:DAVIS, AMAYANA RAMIRO (PT)
Entity Type:Individual
Prefix:MRS
First Name:AMAYANA
Middle Name:RAMIRO
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 1:2233 MISTY CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9219
Mailing Address - Country:US
Mailing Address - Phone:706-513-7843
Mailing Address - Fax:479-709-7733
Practice Address - Street 1:2787 N DECATUR RD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5919
Practice Address - Country:US
Practice Address - Phone:706-513-7843
Practice Address - Fax:479-709-7733
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008050225100000X
FLPT12101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist