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1629098827

NPI Code Detail

MEDICARE: LINDA EILEEN DAVIS MSPT

MEDICARE: LINDA EILEEN DAVIS MSPT

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	J1-0001917	DE
2	2251S0007X	Sports Physical Therapist	J1-0001917	DE
3	2251X0800X	Orthopedic Physical Therapist	J1-0001917	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	88760518	OTHER		CAREFIRST
2	1629098827	OTHER		TRICARE
3	11534468	OTHER		CAQH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2714054000	OTHER		IBC AMERIHEALTH
6	5070-0072	OTHER		NCA

General Provider Information

NPI Number	:	1629098827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA EILEEN DAVIS MSPT

Provider Business Mailing Address
First Line	:	790 REMINGTON BLVD
Second Line	:
City	:	BOLINGBROOK
State	:	IL
Zip	:	60440-4909
Country	:	US
Telephone Number	:	302-677-0100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1288 S GOVERNORS AVE
Second Line	:
City	:	DOVER
State	:	DE
Zip	:	19904-4802
Country	:	US
Telephone Number	:	302-677-0100
Fax Number	:	302-677-0267

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	03/04/2013

Similar Medicare Providers

1659334746 — BROWN & ASSOCIATES SPORTS & ORTHOPAEDIC PHYSICAL THERAPY, P.A.
Practice Location Address:

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1881789246 — SUSAN L PENDER MPT
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Directions to “ LINDA EILEEN DAVIS MSPT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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