Individual
ANDREA S DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
5949 W RAYMOND ST, INDIANAPOLIS, IN 46241-4348
(317) 390-5575
(317) 486-2189
Mailing address
5949 W RAYMOND ST, INDIANAPOLIS, IN 46241-4348
(317) 390-5575
(317) 486-2189
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
06003450A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06003450A
PTA LICENSE
IN
Enumeration date
10/03/2006
Last updated
07/08/2007
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