Anita Davidson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070004540 Issued in IL

Practice address

222 S Greenleaf St
Suite 101
Gurnee, IL 60031-5705

Phone

(847) 599-9171

NPI assigned

Aug 25, 2010

Sex

Female

Sole proprietor

Yes

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.

• Creative Rehab, Inc.

  • Physical Therapy Clinic/Center
  • Gurnee, IL
  • NPI 1487723359

  IL

  Medicare reassignment NPD Authorized official

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 25, 2010.

{
    "created_epoch": "1282694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1282694400000",
    "number": "1538475751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4835 KINGS WAY W",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600313257",
            "telephone_number": "847-599-9171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S GREENLEAF ST",
            "address_2": "SUITE 101",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600315705",
            "telephone_number": "847-599-9171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ANITA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-25",
        "last_updated": "2010-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070004540",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lola Marie Ciccone Damato, LCPC, NCC
• Dana Steiner, LTD
• Archana A Dave, MS, MBA
• David B. Shanker, M.D.
• David L. Gates and Associates
• Philip Wesley Davidson, D.C
• Susan Roberta Davis, LCPC, CDS
• Christopher Noche De Leon, PTA
• Deerpath Physicians Group LTD
• Omaima Degani, M.D.

• All providers in Gurnee, IL
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2010; 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.