MEDICARE: COLTON CHASE DAVIDSON

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	1289547	TX

General Provider Information

NPI Number	:	1174053102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLTON CHASE DAVIDSON

Provider Business Mailing Address
First Line	:	638 UPTOWN BLVD STE 110
Second Line	:
City	:	CEDAR HILL
State	:	TX
Zip	:	75104-3539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	709 ED HALL DR STE B
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1878
Country	:	US
Telephone Number	:	972-608-3939
Fax Number	:	972-608-3938

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

Provider Enumeration Date	:	06/13/2017
Last Update Date	:	05/07/2026

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Directions to “ COLTON CHASE DAVIDSON ” Practice Location

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