Provider Demographics
NPI:1922632116
Name:DAVIS, JOSHUA BLAKE (PT, DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:BLAKE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JACK WHITE DR STE 10
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2379
Mailing Address - Country:US
Mailing Address - Phone:423-392-0469
Mailing Address - Fax:
Practice Address - Street 1:116 JACK WHITE DR STE 10
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2379
Practice Address - Country:US
Practice Address - Phone:423-392-0469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCCP001297T225100000X
TN12726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty