=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194650333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK ADRIAN DAVIS PTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2026
-----------------------------------------------------
Last Update Date | 06/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5230 ROGERS RD BLDG 4
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-809-6760
-----------------------------------------------------
Fax | 210-455-8293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5230 ROGERS RD BLDG 4
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78251-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-809-6760
-----------------------------------------------------
Fax | 210-455-8293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | 2143192
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------