Provider Demographics
NPI:1972264430
Name:DAVIS, STEPHANIE CHRISTINE
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:CHRISTINE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 BUCKBERRY DR # 1974
Mailing Address - Street 2:
Mailing Address - City:SAPPHIRE
Mailing Address - State:NC
Mailing Address - Zip Code:28774-6606
Mailing Address - Country:US
Mailing Address - Phone:815-483-8487
Mailing Address - Fax:
Practice Address - Street 1:3195 OLD MURPHY RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-7213
Practice Address - Country:US
Practice Address - Phone:828-524-7806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP20939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist