Healthcare Provider Details

I. General information

NPI: 1588893671
Provider Name (Legal Business Name): AMANDA F DAVIS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BAKER AVE
CLANTON AL
35045-2337
US

IV. Provider business mailing address

PO BOX 1200
CLANTON AL
35046-1200
US

V. Phone/Fax

Practice location:
  • Phone: 205-280-6450
  • Fax: 205-280-6451
Mailing address:
  • Phone: 205-280-6450
  • Fax: 205-280-6451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH5607
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier51109075
Identifier TypeOTHER
Identifier StateAL
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: