Provider Demographics
NPI:1902898109
Name:DAVIS, JAMES LARRY (MED PT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:LARRY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MED PT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:123 MEDICAL DR
Mailing Address - Street 2:B
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-8510
Mailing Address - Country:US
Mailing Address - Phone:903-729-8616
Mailing Address - Fax:903-729-8618
Practice Address - Street 1:123 MEDICAL DR
Practice Address - Street 2:B
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-8508
Practice Address - Country:US
Practice Address - Phone:903-729-8616
Practice Address - Fax:903-729-8618
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1014645225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y26396Medicare UPIN
801517Medicare ID - Type Unspecified