MEDICARE: CONNOR MICHAEL DAVIS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	P22955	NC

General Provider Information

NPI Number	:	1205690211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNOR MICHAEL DAVIS DPT

Provider Business Mailing Address
First Line	:	2505 KILBORNE DR APT A
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-5377
Country	:	US
Telephone Number	:	704-771-8205
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 BRANCHVIEW DR NE STE 160
Second Line	:
City	:	CONCORD
State	:	NC
Zip	:	28025-2234
Country	:	US
Telephone Number	:	704-782-1322
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	02/09/2024

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