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Individual

MRS. STEPHANIE LYNN DAVIDSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
2603 W PLEASANT GROVE RD, STE 104, ROGERS, AR 72758-5804
(479) 636-1187
(479) 636-1197
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
2014038484
MO
225100000X
Physical Therapist
Primary
PT 2892
AR
225100000X
Physical Therapist
PT9349
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
756620
OPTUM
01
MA4370093
MEDICARE PTAN
MO
01
USES NPI
BCBS-ANTHEM
Enumeration date
08/17/2007
Last updated
01/19/2015
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