Provider Demographics
NPI:1710158233
Name:DAVIS, JOSEPH (ATC/L)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3131 W ORANGEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61060-9709
Mailing Address - Country:US
Mailing Address - Phone:815-821-4622
Mailing Address - Fax:
Practice Address - Street 1:1045 W STEPHENSON STREET
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032
Practice Address - Country:US
Practice Address - Phone:815-599-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer