MEDICARE: MS. NANCY L DAVISON 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	1839	NV

General Provider Information

NPI Number	:	1487655205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY L DAVISON PT

Provider Business Mailing Address
First Line	:	PO BOX 3450
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89702-3450
Country	:	US
Telephone Number	:	775-882-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	3430 EXECUTIVE POINTE WAY
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89706-7946
Country	:	US
Telephone Number	:	775-882-2211
Fax Number	:

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	11/08/2007

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