Provider Demographics
NPI:1740212455
Name:DAVIS-BARTH, ALYSHA P (DPT)
Entity type:Individual
Prefix:
First Name:ALYSHA
Middle Name:P
Last Name:DAVIS-BARTH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 JASON PL
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-2018
Mailing Address - Country:US
Mailing Address - Phone:217-483-5858
Mailing Address - Fax:217-483-5855
Practice Address - Street 1:1089 JASON PL
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-2018
Practice Address - Country:US
Practice Address - Phone:217-483-5858
Practice Address - Fax:217-483-5855
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013030208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070013030OtherSTATE LICENSE