Provider Demographics
NPI:1457876682
Name:DAVIS, JANCY A (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JANCY
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N WOOD AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4000
Mailing Address - Country:US
Mailing Address - Phone:908-925-9700
Mailing Address - Fax:908-663-2551
Practice Address - Street 1:822 N WOOD AVE STE 3
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4000
Practice Address - Country:US
Practice Address - Phone:908-925-9700
Practice Address - Fax:908-663-2551
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00074400225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QB000744700OtherNEW JERSEY STATE BOARD OF PHYSICAL THERAPY