Provider Demographics
NPI:1932173630
Name:DAVIS, JAMIE M (MPT)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2206 SPEDALE COURT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174
Mailing Address - Country:US
Mailing Address - Phone:615-302-2121
Mailing Address - Fax:615-302-2122
Practice Address - Street 1:2206 SPEDALE COURT
Practice Address - Street 2:SUITE 5
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174
Practice Address - Country:US
Practice Address - Phone:615-302-2121
Practice Address - Fax:615-302-2122
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN46631Medicare ID - Type UnspecifiedGROUP