MEDICARE: SYDNEY DAVIS

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	PT004944	WV

General Provider Information

NPI Number	:	1528995164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY DAVIS

Provider Business Mailing Address
First Line	:	1500 GRAND CENTRAL AVE STE 101
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-1079
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 GRAND CENTRAL AVE STE 101
Second Line	:
City	:	VIENNA
State	:	WV
Zip	:	26105-1079
Country	:	US
Telephone Number	:	304-693-2781
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “ SYDNEY DAVIS ” Practice Location

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