Provider Demographics
NPI:1861492159
Name:DAVIS, GREGORY K (PT)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19056-1423
Mailing Address - Country:US
Mailing Address - Phone:215-343-3300
Mailing Address - Fax:215-943-6330
Practice Address - Street 1:2300 TRENTON RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19056-1423
Practice Address - Country:US
Practice Address - Phone:215-343-3300
Practice Address - Fax:215-943-6330
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT08038L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA065046Medicare ID - Type Unspecified