Theresa Davis

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2017036512 Issued in MO

Practice address

2963 Doddridge Ave
Maryland Heights, MO 63043-1736

Phone

(314) 291-4557

NPI assigned

Oct 24, 2021

Last updated

Oct 24, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1635033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635033600000",
    "number": "1548924822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 ROTH AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631302542",
            "telephone_number": "314-267-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2963 DODDRIDGE AVE",
            "city": "MARYLAND HEIGHTS",
            "state": "MO",
            "postal_code": "630431736",
            "telephone_number": "314-291-4557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "THERESA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-24",
        "last_updated": "2021-10-24",
        "certification_date": "2021-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MO",
            "license": "2017036512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebekah Crown
• CRPT, LLC (ApexNetwork Physical Therapy)
• Nicolas Matthew Cruz, M.ED., LPC
• Richard Culligan
• James Robert Davila, RPH
• Daybreak Adult Daycare Center LLC
• Melinda E Declue, BCABA
• Dennis M Anglim DDS PC
• Noelia Dillingham
• Michele A Dintleman, PT

• Physical Therapy Assistant in Maryland Heights, MO
• Providers in Maryland Heights, MO by specialty
• Physical Therapy Assistant in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2021; 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.