Individual
GRACE DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
600 MEDICAL CENTER DR, SEWELL, NJ 08080-2361
(856) 582-8700
Mailing address
112 AZALEA DR, DEPTFORD, NJ 08096-6637
(609) 220-5044
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
40QA00529300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
QA05293
STATE LICENSE NUMBER
NJ
Enumeration date
05/26/2006
Last updated
02/20/2021
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