Provider Demographics
NPI:1770607749
Name:DAVIS, JOHN M (MONTY) (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:M (MONTY)
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 CALIHAN RD
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-6892
Mailing Address - Country:US
Mailing Address - Phone:479-675-6779
Mailing Address - Fax:
Practice Address - Street 1:596 CALIHAN RD
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927-6892
Practice Address - Country:US
Practice Address - Phone:479-675-6779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARS84072Medicare UPIN
AR5U324Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER