Matthew Davis, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

A9209 Issued in LA

Practice address

650 Olive St
Shreveport, LA 71104-2210

Phone

(318) 302-6000

NPI assigned

Jan 3, 2020

Sex

Male

Sole proprietor

No

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

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.

• Riley Physical Therapy, Inc

  • Physical Therapist
  • Shreveport, LA
  • NPI 1356814826
  NPD

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

{
    "created_epoch": "1578009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1578009600000",
    "number": "1972142214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4702 ERIN LN",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711096215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 OLIVE ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711042210",
            "telephone_number": "318-302-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "MATTHEW",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-01-03",
        "last_updated": "2020-01-03",
        "certification_date": "2020-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "LA",
            "license": "A9209",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kurvis Antione Davis
• Lakimberly Davis, LPN
• Lillie Davis
• Marlo Davis
• Mary J. Davis
• Mechelle Davis
• Megan Lashun Davis, LMT
• Nedra Davis
• Paul Corkran Davis, M.D.
• Paul Michael Davis, M.D.

• Physical Therapy Assistant in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Physical Therapy Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2020; 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.