=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750607719
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBROSIA DAVIDA SCOTT PT, DPT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2010
-----------------------------------------------------
Last Update Date | 07/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2867 POPLAR AVE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38111-2023
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-458-5249
-----------------------------------------------------
Fax | 901-458-9052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2867 POPLAR AVENUE
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-458-5249
-----------------------------------------------------
Fax | 901-458-9052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1182087
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 8898
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------