Provider Demographics
NPI:1932327988
Name:DAVISON, STEVEN
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:DAVISON
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STEVEN
Other - Middle Name:PAUL
Other - Last Name:DAVISON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11867
Mailing Address - Street 2:CMS - CCS
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93775-1867
Mailing Address - Country:US
Mailing Address - Phone:559-600-3229
Mailing Address - Fax:559-445-2772
Practice Address - Street 1:1221 FULTON MALL
Practice Address - Street 2:CMS - CCS
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93721-1915
Practice Address - Country:US
Practice Address - Phone:559-600-3229
Practice Address - Fax:559-445-2772
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13305225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist