Healthcare Provider Details

I. General information

NPI: 1346213428
Provider Name (Legal Business Name): ANTHONY JAMES DAVIS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MONTAUK HWY
COPIAGUE NY
11726
US

IV. Provider business mailing address

1160 MONTAUK HWY
COPIAGUE NY
11726
US

V. Phone/Fax

Practice location:
  • Phone: 630-842-4606
  • Fax: 631-842-0803
Mailing address:
  • Phone: 630-842-4606
  • Fax: 631-842-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0137261
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: