Individual
MICHAEL EDWARD DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
4601 DALE RD, MODESTO, CA 95356
(209) 735-4048
Mailing address
3609 DIX LN, MODESTO, CA 95356-1747
(209) 527-2658
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
AT 00635
CA
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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