Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 6849 | NC |
N | 225100000X | Physical Therapist | PT26341 | FL |
N | 2251N0400X | Physical Therapist - Neurology | 6849 | NC |
NPI | 1558393140 |
---|---|
Provider Name | Mr. Thomas Davis |
First Address | Raleigh, NC 27607-5253 |
Second Address | Raleigh, NC 27607-5253 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 04/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
891168N | (05) | NC |