Individual
JASON MICAH DAVENPORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
727 SE MAIN ST, STE 200, SIMPSONVILLE, SC 29681-3247
(864) 454-6670
Mailing address
103 N MAIN ST, STE 300, GREENVILLE, SC 29601-2796
(864) 528-5700
(864) 528-5701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6200
SC
Other
Enumeration date
06/30/2010
Last updated
06/25/2014
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