MEDICARE: BRITTNEY QUINTERA DAVIS

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	PTH9211	AL

General Provider Information

NPI Number	:	1104395342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTNEY QUINTERA DAVIS

Provider Business Mailing Address
First Line	:	111 RACCOON TRCE
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-4023
Country	:	US
Telephone Number	:	256-721-6096
Fax Number	:

Provider Business Practice Location Address
First Line	:	13596 HIGHWAY 231 431 N STE 7
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8618
Country	:	US
Telephone Number	:	256-828-0312
Fax Number	:

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

Provider Enumeration Date	:	11/16/2018
Last Update Date	:	11/16/2018

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