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General NPI Number Information
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NPI Number | 1114941101
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Entity Type | Individual
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Provider Name | ROGER A DAVIS II PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 2420 LIME KILN LN STE C
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City | LOUISVILLE
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State | KY
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Zip | 40222-3425
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Country | US
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Telephone | 502-630-3296
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Fax | 502-630-3302
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Provider Business Mailing Address
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Address Line | 6397 LEE HWY STE 300
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City | CHATTANOOGA
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State | TN
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Zip | 37421-4915
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Country | US
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Telephone | 423-238-8930
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Fax | 423-254-5217
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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