Provider Demographics
NPI:1952303406
Name:DAVISON, ANTHONY (MSPT)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DAVISON
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W FM 544
Mailing Address - Street 2:SUITE 140
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-7049
Mailing Address - Country:US
Mailing Address - Phone:972-442-1177
Mailing Address - Fax:972-442-1434
Practice Address - Street 1:2901 W FM 544
Practice Address - Street 2:SUITE 140
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7049
Practice Address - Country:US
Practice Address - Phone:972-442-1177
Practice Address - Fax:972-442-1434
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX160309401Medicaid
TX659771OtherBLUE CROSS BLUE SHIELD
TX659771OtherBLUE CROSS BLUE SHIELD