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General NPI Number Information
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NPI Number | 1265594501
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Entity Type | Organization
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Legal Business Name | ADVANCED MEDICAL TEAM PA
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 05/03/2019
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Provider Practice Location Address
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Address Line | 2934 KEMP BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1017
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Country | US
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Telephone | 940-264-1960
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Fax | 940-264-1970
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Provider Business Mailing Address
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Address Line | 2934 KEMP BLVD
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City | WICHITA FALLS
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State | TX
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Zip | 76308-1017
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Country | US
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Telephone | 940-264-1960
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Fax | 940-264-1970
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Authorized Official
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Title or Position | OWNER
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Name | DR. RENSAY M DAVIS
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Credential | DC
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Telephone | 940-264-1960
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 9671
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 6286
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License Number State | TX
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