Provider Demographics
NPI:1760507727
Name:DAVIS, JEFFREY TODD (LAT)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 MONA DR
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-6040
Mailing Address - Country:US
Mailing Address - Phone:903-234-8911
Mailing Address - Fax:903-668-5990
Practice Address - Street 1:#1 BOBCAT LANE
Practice Address - Street 2:
Practice Address - City:HALLSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75650-0810
Practice Address - Country:US
Practice Address - Phone:903-668-5990
Practice Address - Fax:903-668-5990
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT10692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer