Angela Jean Davidson

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06000564A Issued in IN

Practice address

1415 Country Club Rd
Mount Vernon, IN 47620-9301

Phone

(812) 838-6554

Fax

(812) 838-9685

NPI assigned

Mar 8, 2010

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": "1268006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268006400000",
    "number": "1710200688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1530 CASS AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477143604",
            "telephone_number": "812-471-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 COUNTRY CLUB RD",
            "city": "MOUNT VERNON",
            "state": "IN",
            "postal_code": "476209301",
            "telephone_number": "812-838-6554",
            "fax_number": "812-838-9685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "ANGELA",
        "middle_name": "JEAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-08",
        "last_updated": "2010-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06000564A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sharon Marie Bush
• Lois Jean Butler, PH.D., LMFT
• Lynn W Clark, MS, CCC-SLP
• Richard J Couture, MA LCSW
• Mandy Dawn Cummins, COTA
• Deaconess Clinc Inc (Deaconess Clinic I)
• Deaconess Clinic, Inc
• Chris Alfonso Diaz, ATC
• Amy Dickerson, PHARMD
• Carrie Dunn

• Physical Therapy Assistant in Mount Vernon, IN
• Providers in Mount Vernon, IN by specialty
• Physical Therapy Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2010; 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.