Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175F00000X | Naturopath | 94 | MT |
Y | 225100000X | Physical Therapist | PTH7285 | AL |
NPI | 1083839237 |
---|---|
Provider Name | Dr. Robert Wayne Davis |
First Address | Livingston, AL 35470-0006 |
Second Address | Livingston, AL 35470-0006 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 08/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
203555096 | (02) | CO |