Provider Demographics
NPI:1447378252
Name:DAVIS, STEVEN LEE (PTA)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:LEE
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1047 BEXLEY RUN APT B
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3373
Mailing Address - Country:US
Mailing Address - Phone:317-885-1549
Mailing Address - Fax:
Practice Address - Street 1:1047 BEXLEY RUN APT B
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3373
Practice Address - Country:US
Practice Address - Phone:317-885-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06001602A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant