Provider Demographics
NPI:1720039506
Name:DAVIDSON, BRIAN B (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:B
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 N COLUMBUS ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-8185
Mailing Address - Country:US
Mailing Address - Phone:740-687-3346
Mailing Address - Fax:740-689-9736
Practice Address - Street 1:2405 N COLUMBUS ST
Practice Address - Street 2:SUITE 220
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-8185
Practice Address - Country:US
Practice Address - Phone:740-687-3346
Practice Address - Fax:740-689-9736
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2506225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0449107Medicaid
OH0449107Medicaid