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Individual
JACKIE LYN DAVIS
Active
Individual
JACKIE LYN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0218191
NY
225100000X
Physical Therapist
PT014053L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011264701
UNIVECA
NY
01
—
000626459001
BCBS WNY
NY
01
—
6697122
GHI
NY
Enumeration date
11/20/2006
Last updated
07/08/2007
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