Provider Demographics
NPI:1720099393
Name:DAVIDSON, DAVID EDWARD SR (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:DAVIDSON
Suffix:SR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1919 NORTH LOOP WEST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77008-1364
Mailing Address - Country:US
Mailing Address - Phone:713-864-0556
Mailing Address - Fax:713-864-1059
Practice Address - Street 1:1919 NORTH LOOP W
Practice Address - Street 2:SUITE 430
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1374
Practice Address - Country:US
Practice Address - Phone:713-864-0556
Practice Address - Fax:713-864-1059
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007458225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ533OtherBLUE CROSS BLUE SHIELD
TXZ06500293Medicaid
TXZ06500293Medicaid