Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 2079119 | TX |
NPI | 1003395401 |
---|---|
Provider Name | Megan Heather Davis |
First Address | Copperas Cove, TX 76522-7736 |
Second Address | Copperas Cove, TX 76522-7736 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2018 |
Last Update Date | 07/08/2018 |