Brian R Davison, PTA
Individual provider Active NPI Physical Therapy Assistant · Lynn Haven, FL
NPI 1992375349 · NPPES record last updated Jun 28, 2021
Key facts
- NPI
- 1992375349
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA30607 (FL)
- Practice address
- 2211 S Highway 77 Ste 200
Lynn Haven, FL 32444-4641 - Phone
- (850) 252-1414
- NPI assigned
- Jun 28, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA30607 | FL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Excellence Physical Therapy LLC | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA30607 | FL | Yes |
Addresses
Primary practice location
2211 S Highway 77 Ste 200
Lynn Haven, FL 32444-4641
Mailing address
12202 Lyndell Plantation Dr
Panama City Beach, FL 32407-2620
Phone (850) 691-9144
Other providers in Lynn Haven, FL
- Charles Corum
- Kristin Craig
- Maria Gina Cruz
- Dale E Mortenson DC PA
- Tisha Davis
- Ivan De la Cruz
- Lori L Deaton
- Sylvia Raye Dee
- Christina M Deegins
- Derek H. Wall DDS PA
All providers in Lynn Haven, FL · Physical Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.