Healthcare Provider Details

I. General information

NPI: 1194603795
Provider Name (Legal Business Name): DELANIE J DAVIS DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2025
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CATOCTIN CIR SE STE 112
LEESBURG VA
20175-3614
US

IV. Provider business mailing address

12701 FAIR LAKES CIR STE 102
FAIRFAX VA
22033-4913
US

V. Phone/Fax

Practice location:
  • Phone: 571-918-0197
  • Fax: 571-918-4253
Mailing address:
  • Phone: 571-918-0197
  • Fax: 571-918-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8049
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP048965T
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: