Organization Name: | DAVIS PHYSICAL THERAPY & SPORTS REHAB, LLC |
NPI Number: | 1063868172 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANDREA JOHNSON DAVIS (OWNER) |
Mailing Address: | 320 Evesboro Medford Rd Marlton |
State: | NJ US |
Postal Code: | 080535733 |
Phone Number: | 6097609619 |
Fax Number: | |
NPI Enumeration Date: | 05/06/2016 |
NPI Last Update Date: | 05/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 40QA00883900 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NJ |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |