Provider Demographics
NPI:1912010521
Name:DAVIS, JOHN MARC (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARC
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-5649
Mailing Address - Country:US
Mailing Address - Phone:919-967-6865
Mailing Address - Fax:
Practice Address - Street 1:JAMES A TAYLOR CAMPUS HEALTH SERVICE
Practice Address - Street 2:101A MANNING DR
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-0001
Practice Address - Country:US
Practice Address - Phone:919-966-6548
Practice Address - Fax:919-843-4771
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC901OtherPHYSICAL THERAPY LICENSE