Mary Jo Davenport, PT, MS, PHD

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT867 Issued in TN

Practice address

807 University Pkwy
Box 70403
Johnson City, TN 37614-1703

Phone

(423) 439-4071

Fax

(423) 439-4060

NPI assigned

Oct 18, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Doctor of Philosophy

State licenses

Practice roles

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.

• East Tennessee State University

  dba Johnson City Downtown Clinic Day Center

  • Federally Qualified Health Center (FQHC)
  • Johnson City, TN
  • NPI 1093990608
  NPD (past)
• East Tennessee State University

  dba Mountain City Extended Hours Health Center

  • Rural Health Clinic/Center
  • Mountain City, TN
  • NPI 1295779361
  NPD (past)

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

{
    "created_epoch": "1350518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350518400000",
    "number": "1447503198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "807 UNIVERSITY PKWY",
            "address_2": "BOX 70403",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376141703",
            "telephone_number": "423-439-4071",
            "fax_number": "423-439-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "MARY JO",
        "credential": "PT, MS, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-10-18",
        "last_updated": "2012-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TN",
            "license": "PT867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ST LIC",
            "identifier": "PT867",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brent Daugherty, PHARM.D.
• Daniel Cameron Daugherty
• Devorah Daught
• Julia E Davenport, FNP
• Katie L Davenport
• Rachel Davenport, NP
• Samuel V Davenport, CRNA
• Carol L Davidson, M.S., CCC-SLP
• Kaydee Louise Davidson, OTR/L
• Adam Wayne Davis

• Physical Therapist in Johnson City, TN
• Providers in Johnson City, TN by specialty
• Physical Therapist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.