MEDICARE: KATHYRN S DAVIS PT

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	1997	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386657898
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHYRN S DAVIS PT

Provider Business Mailing Address
First Line	:	2426 NARROW GAUGE RD
Second Line	:
City	:	REIDSVILLE
State	:	NC
Zip	:	27320-7717
Country	:	US
Telephone Number	:	336-349-4702
Fax Number	:

Provider Business Practice Location Address
First Line	:	281 DOVE RD
Second Line	:
City	:	RUFFIN
State	:	NC
Zip	:	27326-8936
Country	:	US
Telephone Number	:	336-939-3312
Fax Number	:	336-939-7789

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	07/09/2007

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