Individual
BLAINE SCOTT DAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
216 HILLVALE ST, CAPE GIRARDEAU, MO 63701-9571
(619) 655-0289
Mailing address
216 HILLVALE ST, CAPE GIRARDEAU, MO 63701-9571
(619) 655-0289
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2016037346
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2016037346
STATE OF MISSOURI
—
Enumeration date
02/25/2022
Last updated
02/25/2022
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