Basic Information
| Provider Information | |||||||||
| NPI: | 1902096506 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS-PEYTON | ||||||||
| FirstName: | DIANNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1605 SCHERM RD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | OWENSBORO | ||||||||
| State: | KY | ||||||||
| PostalCode: | 423015300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2706859499 | ||||||||
| FaxNumber: | 2706859443 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 INDUSTRIAL PARK RD | ||||||||
| Address2: | |||||||||
| City: | DAWSON SPRINGS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 424082423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2703771600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2007 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 002248 | KY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 002248 | 01 | KY | KENTUCKY LICENSE NUMBER | OTHER |