Provider Demographics
NPI:1972902617
Name:DAVI, KEVIN T (DPT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:T
Last Name:DAVI
Suffix:
Gender:M
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:PO BOX 3524
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90408-3524
Mailing Address - Country:US
Mailing Address - Phone:800-507-2634
Mailing Address - Fax:310-774-3652
Practice Address - Street 1:2222 PICO BLVD UNIT 102
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1776
Practice Address - Country:US
Practice Address - Phone:800-507-2634
Practice Address - Fax:310-774-3652
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2015-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11037225100000X
2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic