Individual
PHILIP DARREN DAVIDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
410 E 22ND ST, FREMONT, NE 68025-2639
(800) 974-4378
(630) 515-1536
Mailing address
24014 W RENWICK RD UNIT 206, PLAINFIELD, IL 60544-8711
(800) 974-4378
(630) 515-1536
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1061
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0586354
—
IA
01
—
6535
BLUE CROSS BLUE SHIELD
NE
Enumeration date
11/14/2005
Last updated
08/22/2023
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