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: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW STE 204
SUPPLY NC
28462-4094
US

IV. Provider business mailing address

20 MEDICAL CAMPUS DR NW STE 204
SUPPLY NC
28462-4094
US

V. Phone/Fax

Practice location:
  • Phone: 910-755-5861
  • Fax: 910-755-5865
Mailing address:
  • Phone: 910-755-5861
  • Fax: 910-755-5865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberP21773
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: