Individual
JEFFREY M DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
275 S 5TH AVE STE 140, POCATELLO, ID 83201-6410
(208) 232-4267
(208) 232-4268
Mailing address
275 S 5TH AVE STE 140, POCATELLO, ID 83201-6410
(208) 232-4267
(208) 232-4268
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT 2240
NV
225100000X
Physical Therapist
PT-2487
ID
Other
Enumeration date
08/13/2008
Last updated
02/11/2009
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