Provider Demographics
NPI:1720569080
Name:DAVIDSON, HAL ALEXANDER (PTA)
Entity Type:Individual
Prefix:
First Name:HAL
Middle Name:ALEXANDER
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S HIGHWAY 36 BYP N
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-2764
Mailing Address - Country:US
Mailing Address - Phone:254-865-6293
Mailing Address - Fax:254-404-2255
Practice Address - Street 1:300 S HIGHWAY 36 BYP N
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528-2764
Practice Address - Country:US
Practice Address - Phone:254-865-7575
Practice Address - Fax:254-404-2255
Is Sole Proprietor?:No
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant