Basic Information
| Provider Information | |||||||||
| NPI: | 1467971630 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | ANDREW | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10014 N RODNEY PARHAM RD STE 103 | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722275598 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012245454 | ||||||||
| FaxNumber: | 5012245460 | ||||||||
| Practice Location | |||||||||
| Address1: | 4540 JFK BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017585555 | ||||||||
| FaxNumber: | 5017585941 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 4396 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.