Jefferson David

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

295052 Issued in CA

Practice address

300 Fountaingrove Pkwy
Santa Rosa, CA 95403-5720

Phone

(707) 359-5005

NPI assigned

Jul 8, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA, AZ2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248

  AZ, Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625788800000",
    "number": "1699346957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 RANDALL LN UNIT B",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954094117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 FOUNTAINGROVE PKWY",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954035720",
            "telephone_number": "707-359-5005"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "34 Randall Ln Unit B",
            "address_purpose": "LOCATION",
            "city": "Santa Rosa",
            "state": "CA",
            "postal_code": "954094117",
            "country_code": "US",
            "telephone_number": "415-684-3423",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "725 Grove St",
            "address_purpose": "LOCATION",
            "city": "Healdsburg",
            "state": "CA",
            "postal_code": "954484756",
            "country_code": "US",
            "telephone_number": "707-433-4877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVID",
        "first_name": "JEFFERSON",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-07-08",
        "last_updated": "2021-07-09",
        "certification_date": "2021-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "295052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clay Breckinridge Daulton, L.AC.
• Charles Anthony Davenport
• Temalesi Caginivalu Daveta
• David Lincoln Chiropractic PC
• Frederick Charles David, M.D.
• Delaney Davidge
• Jenny J Davidson
• Jill Hutton Davidson, NP
• Jill M Davidson
• Russell Davidson

• Physical Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2021; 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.