MEDICARE: LORA DAVIS PT

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	107466	MO

General Provider Information

NPI Number	:	1801293295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA DAVIS PT

Provider Business Mailing Address
First Line	:	11621 FRANCETTA LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1719
Country	:	US
Telephone Number	:	314-303-8652
Fax Number	:

Provider Business Practice Location Address
First Line	:	11621 FRANCETTA LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63138-1719
Country	:	US
Telephone Number	:	314-303-8652
Fax Number	:

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

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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Directions to “ LORA DAVIS PT” Practice Location

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