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NPI Code Detail

MEDICARE: LYNDA DIANE DAVIS PTA

MEDICARE: LYNDA DIANE DAVIS PTA
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
1225200000XPhysical Therapy AssistantPTA619FL

General Provider Information

NPI Number : 1043538697
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNDA DIANE DAVIS PTA
Provider Business Mailing Address
First Line : 16002 LAKESHORE VILLA DR
Second Line :
City : TAMPA
State : FL
Zip : 33613-1367
Country : US
Telephone Number : 813-968-5093
Fax Number : 813-968-5934
Provider Business Practice Location Address
First Line : 16002 LAKESHORE VILLA DR
Second Line :
City : TAMPA
State : FL
Zip : 33613-1367
Country : US
Telephone Number : 813-968-5093
Fax Number : 813-968-5934
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/06/2010
Last Update Date : 05/06/2010

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