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NPI Code Detail

MEDICARE: DAVIS D TARKENTON

MEDICARE: DAVIS D TARKENTON
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
1225100000XPhysical TherapistCP052206TGA
2225100000XPhysical Therapist2305216252VA

General Provider Information

NPI Number : 1700648417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVIS D TARKENTON
Provider Business Mailing Address
First Line : PO BOX 412307
Second Line :
City : BOSTON
State : MA
Zip : 02241-2307
Country : US
Telephone Number : 914-294-4050
Fax Number :
Provider Business Practice Location Address
First Line : 2610 BUFORD RD
Second Line :
City : NORTH CHESTERFIELD
State : VA
Zip : 23235-3422
Country : US
Telephone Number : 804-923-3933
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/29/2024
Last Update Date : 02/05/2026

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Directions to “ DAVIS D TARKENTON ” Practice Location

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