Individual
DAVIS NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, DPT
Contact information
Practice address
16111 SE MCGILLIVRAY BLVD STE A, VANCOUVER, WA 98683-9033
(360) 253-4020
Mailing address
16111 SE MCGILLIVRAY BLVD STE A, VANCOUVER, WA 98683-9033
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
63789
OR
Other
Enumeration date
08/27/2020
Last updated
08/27/2020
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