Individual
MARY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
195 MATTIE M KELLY BLVD, DESTIN, FL 32541-2811
(850) 654-4588
(850) 424-7483
Mailing address
101 E STATE ST, KENNETT SQUARE, PA 19348-3109
(610) 444-6350
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA24579
FL
Other
Enumeration date
10/21/2015
Last updated
10/21/2015
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