Provider Demographics
NPI:1770277287
Name:DAVIS, WILLIAM R JR (PTA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:DAVIS
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 E REEL LOOP
Mailing Address - Street 2:
Mailing Address - City:DUNNELLON
Mailing Address - State:FL
Mailing Address - Zip Code:34434-4219
Mailing Address - Country:US
Mailing Address - Phone:352-201-8832
Mailing Address - Fax:
Practice Address - Street 1:6843 N CITRUS AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34428-6933
Practice Address - Country:US
Practice Address - Phone:352-322-6093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-07
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA32396225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant