Provider Demographics
NPI:1104473339
Name:DAVIDSON, SHAWN E (DPT)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:E
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 HOLLY AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2554
Mailing Address - Country:US
Mailing Address - Phone:505-797-5505
Mailing Address - Fax:505-797-5510
Practice Address - Street 1:7424 HOLLY AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87113-2554
Practice Address - Country:US
Practice Address - Phone:505-797-5505
Practice Address - Fax:505-797-5510
Is Sole Proprietor?:No
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT5550225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist