Healthcare Provider Details

I. General information

NPI: 1588696934
Provider Name (Legal Business Name): CARA DAVIS MSPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARA CHICKANOSKY PT

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 SUMMER ST
KINGSTON MA
02364-1282
US

IV. Provider business mailing address

1 CREDIT UNION WAY FL 3
RANDOLPH MA
02368-4633
US

V. Phone/Fax

Practice location:
  • Phone: 781-585-8588
  • Fax: 781-585-1279
Mailing address:
  • Phone: 781-961-3370
  • Fax: 781-961-1291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number23564
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number7532
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: