Provider Demographics
NPI:1932082492
Name:DAVIS, TOMMIE LEROY JR (PTA)
Entity type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:LEROY
Last Name:DAVIS
Suffix:JR
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 1:61 METTA CREST CIR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26184-3342
Mailing Address - Country:US
Mailing Address - Phone:304-834-6244
Mailing Address - Fax:
Practice Address - Street 1:158 GROSS ST
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-2031
Practice Address - Country:US
Practice Address - Phone:740-374-1422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-30
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5868225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant