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General NPI Number Information
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NPI Number | 1699069112
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Entity Type | Organization
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Legal Business Name | DAVIS SPORTS THERAPY AND REHABILITATION PLLC
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Dates
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Enumeration Date | 06/01/2011
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 611 S CONGRESS AVE STE 205
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City | AUSTIN
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State | TX
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Zip | 78704-1729
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Country | US
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Telephone | 512-442-3200
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Fax | 512-442-3206
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Provider Business Mailing Address
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Address Line | PO BOX 41465
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City | AUSTIN
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State | TX
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Zip | 78704-0025
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Country | US
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Telephone | 512-442-3200
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PHILLIP L DAVIS
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Credential | DPT
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Telephone | 512-442-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 657570000
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License Number State | TX
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