Provider Demographics
NPI:1912385089
Name:DAVIS, JOHN WILLIAM III (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:DAVIS
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 PELHAM RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3600
Mailing Address - Country:US
Mailing Address - Phone:864-918-7562
Mailing Address - Fax:414-208-2378
Practice Address - Street 1:1306 PELHAM RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3600
Practice Address - Country:US
Practice Address - Phone:864-918-7562
Practice Address - Fax:414-208-2378
Is Sole Proprietor?:No
Enumeration Date:2015-05-11
Last Update Date:2022-03-30
Deactivation Date:2020-09-25
Deactivation Code:
Reactivation Date:2022-03-30
Provider Licenses
StateLicense IDTaxonomies
SC7918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7918OtherSOUTH CAROLINA BOARD OF PHYSICAL THERAPY