Provider Demographics
NPI:1902837263
Name:DAVIS, ANTONE LLEWELLYN II (DPTSC, PT)
Entity Type:Individual
Prefix:MR
First Name:ANTONE
Middle Name:LLEWELLYN
Last Name:DAVIS
Suffix:II
Gender:M
Credentials:DPTSC, PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:18791 OAK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-2252
Mailing Address - Country:US
Mailing Address - Phone:714-832-8266
Mailing Address - Fax:714-835-4889
Practice Address - Street 1:1910 OLD TUSTIN AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-7811
Practice Address - Country:US
Practice Address - Phone:714-835-6638
Practice Address - Fax:714-835-4889
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT19242225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT19242AMedicare ID - Type Unspecified