Provider Demographics
NPI:1629026760
Name:DAVIS, PATRICIA M (MS,PT, CSCS,COMT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MS,PT, CSCS,COMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TOWNES PL
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2090
Mailing Address - Country:US
Mailing Address - Phone:540-373-7133
Mailing Address - Fax:540-373-0068
Practice Address - Street 1:3310 FALL HILL AVE
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3000
Practice Address - Country:US
Practice Address - Phone:540-373-7133
Practice Address - Fax:540-373-0068
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305203615225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist