Provider Demographics
NPI:1154352565
Name:DAVIS, ANN (PT)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3967 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2125
Mailing Address - Country:US
Mailing Address - Phone:440-777-7837
Mailing Address - Fax:
Practice Address - Street 1:12221 MADISON AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-5029
Practice Address - Country:US
Practice Address - Phone:216-221-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2582183Medicaid
OH137836OtherANTHEM
OH300629551005OtherMEDICAL MUTUAL
OH877951Medicare ID - Type Unspecified