MEDICARE: MR. JEFFREY ROSS DAVIS P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0002416	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043229867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY ROSS DAVIS P.T.

Provider Business Mailing Address
First Line	:	383 NW 112TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7968
Country	:	US
Telephone Number	:	954-856-3142
Fax Number	:	954-577-9350

Provider Business Practice Location Address
First Line	:	10189 W SUNRISE BLVD
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-7617
Country	:	US
Telephone Number	:	954-577-9370
Fax Number	:	954-577-9350

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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