Provider Demographics
NPI:1396806071
Name:DAVIES, KAREN Y (MPT)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:Y
Last Name:DAVIES
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8232 HALL LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-2314
Mailing Address - Country:US
Mailing Address - Phone:704-660-7070
Mailing Address - Fax:704-664-5575
Practice Address - Street 1:450 STATE ROAD 13 N STE 112
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3861
Practice Address - Country:US
Practice Address - Phone:904-900-5512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9921174400000X
FLPT41635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9921OtherPHYSICAL THERAPIST LICENS