Provider Demographics
NPI:1417132374
Name:DAVILA, STACEE BONITA (DPT)
Entity type:Individual
Prefix:DR
First Name:STACEE
Middle Name:BONITA
Last Name:DAVILA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24820 BURNT PINE DR
Mailing Address - Street 2:STE 4
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-2028
Mailing Address - Country:US
Mailing Address - Phone:239-947-4184
Mailing Address - Fax:239-947-4171
Practice Address - Street 1:24820 BURNT PINE DR
Practice Address - Street 2:STE 4
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-2028
Practice Address - Country:US
Practice Address - Phone:239-947-4184
Practice Address - Fax:239-947-4171
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT238062251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI453ZMedicare PIN