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NPI Code Detail

MEDICARE: JAMIE DAVIS

MEDICARE: JAMIE 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
1225200000XPhysical Therapy AssistantPTA21608FL

General Provider Information

NPI Number : 1861921165
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE DAVIS
Provider Business Mailing Address
First Line : 437 SE THORNHILL DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34983-3741
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 700 S 29TH ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-3626
Country : US
Telephone Number : 772-465-7560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2017
Last Update Date : 06/08/2017

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Directions to “ JAMIE DAVIS ” Practice Location

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