MEDICARE: MIKAL D 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	2305204371	VA
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1548370299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKAL D DAVIS PT

Provider Business Mailing Address
First Line	:	5717 BRADINGTON CT
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-6942
Country	:	US
Telephone Number	:	646-345-5029
Fax Number	:

Provider Business Practice Location Address
First Line	:	11928 IRON BRIDGE PLZ
Second Line	:
City	:	CHESTER
State	:	VA
Zip	:	23831-1441
Country	:	US
Telephone Number	:	804-425-4545
Fax Number	:	804-425-4546

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/01/2024

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