Active NPI
Anthony Davison, MSPT
- Physical Therapist
- Wylie, TX
National Provider Identifier
1952303406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1141802
- Practice address
- 2901 W FM 544
Suite 140
Wylie, TX 75098-7049 - Phone
- (972) 442-1177
- Fax
- (972) 442-1434
- NPI assigned
- Aug 15, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1141802 | TX | Primary |
Addresses
Primary practice location
2901 W FM 544
Suite 140
Wylie, TX 75098-7049
Mailing address
2901 W FM 544
Suite 140
Wylie, TX 75098-7049
Phone (972) 442-1177
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 160309401 | Medicaid | TX | |
| 659771 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20111215000478 | TX | Practitioner - Physical Therapist in Private Practice | 3870768187 | Practice locations: Wylie, TX |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2901 W FM
544 Suite 140
Wylie, TX 75098-7055
Phone (972) 442-1177
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1141802 | TX | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642377600000",
"number": "1952303406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2901 W FM 544",
"address_2": "SUITE 140",
"city": "WYLIE",
"state": "TX",
"postal_code": "750987049",
"telephone_number": "972-442-1177",
"fax_number": "972-442-1434"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2901 W FM 544",
"address_2": "SUITE 140",
"city": "WYLIE",
"state": "TX",
"postal_code": "750987049",
"telephone_number": "972-442-1177",
"fax_number": "972-442-1434"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISON",
"first_name": "ANTHONY",
"credential": "MSPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-08-15",
"last_updated": "2022-01-17",
"certification_date": "2021-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1141802",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "160309401",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "659771",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wylie, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.