Provider Demographics
NPI:1477675197
Name:DAVIS, DAWN W (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:W
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:WHITSON
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:920 16TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1119
Mailing Address - Country:US
Mailing Address - Phone:209-557-1047
Mailing Address - Fax:209-557-6921
Practice Address - Street 1:920 16TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1119
Practice Address - Country:US
Practice Address - Phone:209-557-1047
Practice Address - Fax:209-557-6921
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist