Individual
CHRISTOPHER DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
5306 TRAIL LAKE DR, FORT WORTH, TX 76133-1931
(817) 433-0721
Mailing address
2121 PINCREST DR, TYLER, TX 75701
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2055780
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149984001
—
TX
Enumeration date
12/11/2009
Last updated
12/11/2009
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