Amanda Davenport

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

304560 Issued in CA

Practice address

2495 Truxtun Rd Ste 200
San Diego, CA 92106-6159

Phone

(858) 755-5200

Fax

(619) 223-2307

NPI assigned

Aug 21, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Group practices

Rise Physical Therapy IncGroup PAC ID 2062636079, 55 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rise Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Solana Beach, CA
  • NPI 1083038764
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1692576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692576000000",
    "number": "1366226474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "380 STEVENS AVE STE 314",
            "city": "SOLANA BEACH",
            "state": "CA",
            "postal_code": "920752069",
            "telephone_number": "858-755-5200",
            "fax_number": "858-755-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2495 TRUXTUN RD STE 200",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921066159",
            "telephone_number": "858-755-5200",
            "fax_number": "619-223-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "AMANDA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-21",
        "last_updated": "2023-08-21",
        "certification_date": "2023-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "304560",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edrika Lanay Dave
• Shravan Dave, MD
• Arpna Vajpayee Dave', M.D.
• Jeni D Davenport-Furniss, NBC-HWC, CHES
• Aisha J Davenport
• Dayjahnay Shantay Davenport
• Elizabeth Davenport, LCSW
• Joseph Wesley Davenport Jr.
• Laris Olivia Davenport, RN
• Montgomery S Davenport, LPC

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.