MEDICARE: TAMARA 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	PTA30351	FL

General Provider Information

NPI Number	:	1366051559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA DAVIS PTA

Provider Business Mailing Address
First Line	:	3662 SW STERRICKER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-5034
Country	:	US
Telephone Number	:	609-464-0500
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 SW STERRICKER ST
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34953-5034
Country	:	US
Telephone Number	:	609-464-0500
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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Directions to “ TAMARA DAVIS PTA” Practice Location

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