Provider Demographics
NPI:1730418179
Name:DAVIS, TINA R (PT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:R
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:1818 MICCOSUKEE COMMONS DR
Mailing Address - Street 2:STE #3
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-6400
Mailing Address - Country:US
Mailing Address - Phone:850-656-3163
Mailing Address - Fax:850-656-3463
Practice Address - Street 1:1818 MICCOSUKEE COMMONS DR
Practice Address - Street 2:STE #3
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-6400
Practice Address - Country:US
Practice Address - Phone:850-656-3163
Practice Address - Fax:850-656-3463
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPT 16496225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist