Provider Demographics
NPI:1942206842
Name:DURHAM, DAVID JOE (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JOE
Last Name:DURHAM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7496 LEE DAVIS RD
Mailing Address - Street 2:STE 19
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-3678
Mailing Address - Country:US
Mailing Address - Phone:804-730-7730
Mailing Address - Fax:
Practice Address - Street 1:7496 LEE DAVIS RD
Practice Address - Street 2:STE 19
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-3678
Practice Address - Country:US
Practice Address - Phone:804-730-7730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002366225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAR65356Medicare UPIN