Healthcare Provider Details

I. General information

NPI: 1326444936
Provider Name (Legal Business Name): AUTUMN JOY DAVIS PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 OLD TROY PIKE
DAYTON OH
45424-5740
US

IV. Provider business mailing address

498 SHILOH DR APT 4
DAYTON OH
45415-3441
US

V. Phone/Fax

Practice location:
  • Phone: 937-233-1230
  • Fax: 937-236-8930
Mailing address:
  • Phone: 740-398-2786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT.015120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: