Active NPI
Charles Alexander Davisson
- Physical Therapist
- Bridgeport, WV
National Provider Identifier
1992395818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT004775
- Practice address
- 9905 George Washington Hwy
Bridgeport, WV 26330-7319 - Phone
- (304) 626-5301
- NPI assigned
- Jan 25, 2021
- 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 | PT004775 | WV | Primary |
Addresses
Primary practice location
9905 George Washington Hwy
Bridgeport, WV 26330-7319
Mailing address
9905 George Washington Hwy
Bridgeport, WV 26330-7319
Phone (304) 626-5301
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240930003468 | WV | Practitioner - Physical Therapist in Private Practice | 2264963354 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1611532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1725494400000",
"number": "1992395818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9905 GEORGE WASHINGTON HWY",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263307319",
"telephone_number": "304-626-5301"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9905 GEORGE WASHINGTON HWY",
"city": "BRIDGEPORT",
"state": "WV",
"postal_code": "263307319",
"telephone_number": "304-626-5301"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVISSON",
"first_name": "CHARLES",
"middle_name": "ALEXANDER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-01-25",
"last_updated": "2024-09-05",
"certification_date": "2024-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT004775",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bridgeport, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.