MEDICARE: PETER JAMES 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
1	225200000X	Physical Therapy Assistant	007082	NY

General Provider Information

NPI Number	:	1083848170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JAMES DAVIS PTA

Provider Business Mailing Address
First Line	:	4500 BARKER HILL RD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9566
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 BARKER HILL ROAD
Second Line	:
City	:	JAMESVILLE
State	:	NY
Zip	:	13078-9566
Country	:	US
Telephone Number	:	315-657-4984
Fax Number	:

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

Provider Enumeration Date	:	05/05/2009
Last Update Date	:	05/05/2009

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