=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750847752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE TRAVELING PHYSICAL THERAPIST
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2019
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 STONEHURST LN
-----------------------------------------------------
City | DIX HILLS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11746-7930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-733-4737
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 VETS HWY UNIT 141
-----------------------------------------------------
City | COMMACK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11725-6408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-207-3541
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. DANIEL DAVIDS
-----------------------------------------------------
Credential | PT DPT CSCS
-----------------------------------------------------
Telephone | 646-733-4737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------