Provider Demographics
NPI:1952375982
Name:DAVENPORT, TODD ELDON (DPT OCS)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:ELDON
Last Name:DAVENPORT
Suffix:
Gender:M
Credentials:DPT OCS
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 AEROVISTA PL
Mailing Address - Street 2:201
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7919
Mailing Address - Country:US
Mailing Address - Phone:805-788-0805
Mailing Address - Fax:805-788-0845
Practice Address - Street 1:1716 W HAMMER LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-2922
Practice Address - Country:US
Practice Address - Phone:209-473-2383
Practice Address - Fax:209-473-1350
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 27430225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABF313ZMedicare PIN
CAOPT274300Medicare PIN