Provider Demographics
NPI:1669012829
Name:VERNON-DAVIS, GENA (PT)
Entity Type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:VERNON-DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:GENA
Other - Middle Name:
Other - Last Name:VERNON-DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1500 BLONDELL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2643
Mailing Address - Country:US
Mailing Address - Phone:718-405-8422
Mailing Address - Fax:
Practice Address - Street 1:1825 EASTCHESTER RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2301
Practice Address - Country:US
Practice Address - Phone:718-904-2785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM020222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist