Provider Demographics
NPI:1902096506
Name:DAVIS-PEYTON, DIANNA
Entity Type:Individual
Prefix:
First Name:DIANNA
Middle Name:
Last Name:DAVIS-PEYTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SCHERM RD
Mailing Address - Street 2:STE 1
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-5300
Mailing Address - Country:US
Mailing Address - Phone:270-685-9499
Mailing Address - Fax:270-685-9443
Practice Address - Street 1:225 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:DAWSON SPRINGS
Practice Address - State:KY
Practice Address - Zip Code:42408-2423
Practice Address - Country:US
Practice Address - Phone:270-377-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002248225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY002248OtherKENTUCKY LICENSE NUMBER
KY7100244000Medicaid
KY002248OtherKENTUCKY LICENSE NUMBER
KY002248OtherKENTUCKY LICENSE NUMBER