Provider Demographics
NPI:1699069112
Name:DAVIS SPORTS THERAPY AND REHABILITATION PLLC
Entity type:Organization
Organization Name:DAVIS SPORTS THERAPY AND REHABILITATION PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:L
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:512-442-3200
Mailing Address - Street 1:PO BOX 41465
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-0025
Mailing Address - Country:US
Mailing Address - Phone:512-442-3200
Mailing Address - Fax:
Practice Address - Street 1:611 S CONGRESS AVE STE 205
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-1729
Practice Address - Country:US
Practice Address - Phone:512-442-3200
Practice Address - Fax:512-442-3206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657570000261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy