MEDICARE: KEARSTEN RITCHEL 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	PT24657	FL

General Provider Information

NPI Number	:	1801997572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEARSTEN RITCHEL DAVIS PT

Provider Business Mailing Address
First Line	:	3633 W WATERS AVE
Second Line	:	SUITE 700
City	:	TAMPA
State	:	FL
Zip	:	33614-2783
Country	:	US
Telephone Number	:	813-932-5119
Fax Number	:	813-932-5539

Provider Business Practice Location Address
First Line	:	3633 W WATERS AVE
Second Line	:	SUITE 700
City	:	TAMPA
State	:	FL
Zip	:	33614-2783
Country	:	US
Telephone Number	:	813-932-5119
Fax Number	:	813-932-5539

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/24/2012

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