Individual
ANDREW BLAKE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
298 TRICORN RD, DANVILLE, WV 25053-7148
(304) 369-1385
Mailing address
464 3RD ST, MADISON, WV 25130-1435
(304) 654-5185
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002490
WV
Other
Enumeration date
09/08/2023
Last updated
09/08/2023
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