Provider Demographics
NPI:1639595192
Name:DAVYDOV, MARK (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DAVYDOV
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 RALSTON RD STE 1
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004-4974
Mailing Address - Country:US
Mailing Address - Phone:929-340-1606
Mailing Address - Fax:
Practice Address - Street 1:10050 RALSTON RD STE 1
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004-4974
Practice Address - Country:US
Practice Address - Phone:929-340-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist