Jordan Davis, DPT
Individual provider Active NPI Physical Therapist · Des Peres, MO
NPI 1114378809 · NPPES record last updated Jun 24, 2016
Key facts
- NPI
- 1114378809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 2016021914 (MO)
- Practice address
- 12360 Manchester Rd
Des Peres, MO 63131-4312 - Phone
- (314) 966-8855
- NPI assigned
- Jun 24, 2016
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2016021914 | MO | MD | Physical Therapist |
| 2305210258 | VA | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2016021914 | MO | Yes |
| Physical Therapist | 225100000X | 2305210258 | VA |
Addresses
Primary practice location
12360 Manchester Rd
Des Peres, MO 63131-4312
Mailing address
12360 Manchester Rd
Des Peres, MO 63131-4312
Other providers in Des Peres, MO
- Kathryn Elizabeth Cross
- Kelsey Cunningham
- Tawniece Marie Curry
- CVPT-Des Peres, LLC
- Davidson Vision Therapy LLC
- Sara Anne Day
- Betsaida Anai Delgado
- Michelle Derheimer
- Des Peres Healthcare, LLC
- Des Peres Operations LLC
All providers in Des Peres, MO · Physical Therapist in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.