NPIMap

Organization Active NPI

Davis Physical Therapy & Sports Rehab

  • Physical Therapy Clinic/Center
  • Marlton, NJ
National Provider Identifier
1063868172
Registry record updated Jan 24, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
40QA00883900 Issued in NJ
Legal business name
DAVIS PHYSICAL THERAPY & SPORTS REHAB
Practice address
320 Evesboro Medford Rd
Suite 310
Marlton, NJ 08053-5733
Phone
(609) 694-8896
Fax
(609) 953-1715
NPI assigned
May 6, 2016
Last updated
Jan 24, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Andrea Johnson Davis, DPTNPI 1437247731
Title
Owner
Phone
(609) 694-8896

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 40QA00883900 NJ Primary

Addresses

Primary practice location

320 Evesboro Medford Rd
Suite 310
Marlton, NJ 08053-5733

Mailing address

6 Duncan CT
Medford, NJ 08055-8467
Phone (609) 760-9619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170125000267 NJ Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9436431582 Receives reassigned benefits from 10 practitioners
Practice locations: Medford, NJ

National Provider Directory

National Provider Directory

Locations

320 Evesboro Medford Rd
Ste 310
Marlton, NJ 08053
Phone (609) 694-8896

338 Stokes Rd
Medford, NJ 08055
Phone (609) 451-5404

3 Coleman Ct
Southampton, NJ 08088
Phone (508) 259-5481

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1462492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485216000000",
    "number": "1063868172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 DUNCAN CT",
            "city": "MEDFORD",
            "state": "NJ",
            "postal_code": "080558467",
            "telephone_number": "609-760-9619",
            "fax_number": "609-953-1715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 EVESBORO MEDFORD RD",
            "address_2": "SUITE 310",
            "city": "MARLTON",
            "state": "NJ",
            "postal_code": "080535733",
            "telephone_number": "609-694-8896",
            "fax_number": "609-953-1715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVIS PHYSICAL THERAPY & SPORTS REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-06",
        "last_updated": "2017-01-24",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "JOHNSON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "609-694-8896",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NJ",
            "license": "40QA00883900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlton, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.