MEDICARE: MRS. BARBARA DAVIS RPT

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	265	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	51501081	OTHER	AL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1528188752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA DAVIS RPT

Provider Business Mailing Address
First Line	:	3105 TROTTERS TRL
Second Line	:
City	:	WETUMPKA
State	:	AL
Zip	:	36093-2318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 MONROE ST
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36104-3735
Country	:	US
Telephone Number	:	334-206-5680
Fax Number	:

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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