Provider Demographics
NPI:1043454887
Name:DAVIS, MARSHA L (PT)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:APALACHICOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32329-0207
Mailing Address - Country:US
Mailing Address - Phone:850-653-4545
Mailing Address - Fax:850-653-4949
Practice Address - Street 1:111 AVENUE E
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2041
Practice Address - Country:US
Practice Address - Phone:850-653-4545
Practice Address - Fax:850-653-4949
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY003261225100000X
FLPT12314225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist