Provider Demographics
NPI:1710533252
Name:DAVIS III, JOHN H III (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:DAVIS III
Suffix:III
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 1:4020 N ROCKWELL ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3721
Mailing Address - Country:US
Mailing Address - Phone:312-572-9351
Mailing Address - Fax:312-637-6435
Practice Address - Street 1:4020 N ROCKWELL ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3721
Practice Address - Country:US
Practice Address - Phone:312-572-9351
Practice Address - Fax:312-637-6435
Is Sole Proprietor?:No
Enumeration Date:2019-08-12
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL070024670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program