Healthcare Provider Details

I. General information

NPI: 1952030009
Provider Name (Legal Business Name): MATTHEW GRAHAM DAVIS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2145 COUNTRY CLUB RD STE 200
JACKSONVILLE NC
28546-2404
US

IV. Provider business mailing address

PO BOX 5105
BELFAST ME
04915-5100
US

V. Phone/Fax

Practice location:
  • Phone: 252-726-1802
  • Fax: 252-726-1805
Mailing address:
  • Phone: 252-726-1802
  • Fax: 252-726-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21773
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP20242
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: