Healthcare Provider Details

I. General information

NPI: 1235322769
Provider Name (Legal Business Name): STEPHANIE LYNN DAVIDSON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE LYNN STRACK

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 W PLEASANT GROVE RD STE 104
ROGERS AR
72758-5804
US

IV. Provider business mailing address

8823 PRODUCTION LN
OOLTEWAH TN
37363-6511
US

V. Phone/Fax

Practice location:
  • Phone: 479-636-1187
  • Fax: 479-636-1197
Mailing address:
  • Phone: 423-238-7217
  • Fax: 423-238-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 2892
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT9349
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2014038484
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: