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General NPI Number Information
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NPI Number | 1679812747
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Entity Type | Organization
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Legal Business Name | SHANE DAVIS PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/08/2013
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Last Update Date | 06/27/2025
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Provider Practice Location Address
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Address Line | 13040 STATE ROUTE 12
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City | BOONVILLE
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State | NY
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Zip | 13309-4942
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Country | US
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Telephone | 315-358-4028
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Fax | 315-358-4394
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Provider Business Mailing Address
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Address Line | 13040 STATE ROUTE 12
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City | BOONVILLE
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State | NY
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Zip | 13309-4942
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Country | US
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Telephone | 315-358-4028
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Fax | 315-358-4186
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DR. SHANE DAVIS
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Credential | DPT
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Telephone | 315-358-4028
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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 | 022935
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License Number State | NY
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