Provider Demographics
NPI:1871754697
Name:DAVIS, AMY DAWN (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:DAWN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, DPT
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 5274
Mailing Address - Street 2:
Mailing Address - City:LAKE MONTEZUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:86342-5274
Mailing Address - Country:US
Mailing Address - Phone:928-699-7938
Mailing Address - Fax:
Practice Address - Street 1:505 JACKS CANYON RD
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86351-7856
Practice Address - Country:US
Practice Address - Phone:928-284-2411
Practice Address - Fax:928-284-2439
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6130225100000X, 2251H1200X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic