Provider Demographics
NPI:1316258577
Name:DAVIDSON, DAVID J IV (DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:DAVIDSON
Suffix:IV
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1303 VEALE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4601
Mailing Address - Country:US
Mailing Address - Phone:302-477-0800
Mailing Address - Fax:302-477-0801
Practice Address - Street 1:2060 LIMESTONE RD
Practice Address - Street 2:SUITE B
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5500
Practice Address - Country:US
Practice Address - Phone:302-999-9202
Practice Address - Fax:302-999-9203
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002585208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation