Provider Demographics
NPI:1851616155
Name:DAVIDSON, JOHN CARL JR (DPT,MOTR)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:CARL
Last Name:DAVIDSON
Suffix:JR
Gender:M
Credentials:DPT,MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 38155
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27438-8155
Mailing Address - Country:US
Mailing Address - Phone:336-265-6731
Mailing Address - Fax:336-313-0973
Practice Address - Street 1:3726 BATTLEGROUND AVE STE B
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2344
Practice Address - Country:US
Practice Address - Phone:336-265-6731
Practice Address - Fax:336-313-0973
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP12311225100000X
NC7348225X00000X
VA2305205753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851616155OtherNPI
3B698CH69OtherMEDICARE PTAN