Provider Demographics
NPI:1881786812
Name:DAVIDSON, NEIL ANDREW (DPT)
Entity type:Individual
Prefix:MR
First Name:NEIL
Middle Name:ANDREW
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3208 SERVICE DR.
Mailing Address - Street 2:SUITE E
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-664-2044
Mailing Address - Fax:601-664-3044
Practice Address - Street 1:3208 SERVICE DR.
Practice Address - Street 2:SUITE E
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-664-2044
Practice Address - Fax:601-664-3044
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3639225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7512579OtherAETNA
MS7512579OtherAETNA