Individual
DEREK J DAVIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
300 CHERRY ST, CHANDLER, TX 75758-9636
(903) 849-2485
Mailing address
3961 COUNTY ROAD 1120, TYLER, TX 75704-7407
(903) 752-4385
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2087336
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2087336
—
TX
Enumeration date
08/31/2018
Last updated
08/31/2018
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