Provider Demographics
NPI:1295869881
Name:DAVIS, JEFFREY (LPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3911
Mailing Address - Country:US
Mailing Address - Phone:414-791-7809
Mailing Address - Fax:262-364-2248
Practice Address - Street 1:8619 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2919
Practice Address - Country:US
Practice Address - Phone:414-791-7809
Practice Address - Fax:262-364-2248
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI36102100Medicaid
WI36102100Medicaid
WIK100249753Medicare PIN