Provider Demographics
NPI:1528312188
Name:DAVIDSON, HILLARY MIXON (DPT)
Entity type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:MIXON
Last Name:DAVIDSON
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 1:31 BRIGANTINE CT
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5970
Mailing Address - Country:US
Mailing Address - Phone:843-861-6444
Mailing Address - Fax:
Practice Address - Street 1:319 W TOWN PL
Practice Address - Street 2:SUITE 5
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3101
Practice Address - Country:US
Practice Address - Phone:904-342-5262
Practice Address - Fax:904-217-3580
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist