Provider Demographics
NPI:1881860252
Name:DAVIS, JOHN DALLAS (DPT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DALLAS
Last Name:DAVIS
Suffix:
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 1:5171 CUB LAKE RD
Mailing Address - Street 2:SUITE C- 360
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-7888
Mailing Address - Country:US
Mailing Address - Phone:928-537-0248
Mailing Address - Fax:928-537-0248
Practice Address - Street 1:5171 CUB LAKE RD
Practice Address - Street 2:SUITE C- 360
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-7888
Practice Address - Country:US
Practice Address - Phone:928-537-0248
Practice Address - Fax:928-537-0248
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7781225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ7781OtherPHYSICAL THERAPY LICENSE #: