Provider Demographics
NPI:1053374298
Name:DAVIS, CHRISTINA L (PT)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 PARKSIDE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-2658
Mailing Address - Country:US
Mailing Address - Phone:865-769-4545
Mailing Address - Fax:865-769-4501
Practice Address - Street 1:11440 PARKSIDE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-2658
Practice Address - Country:US
Practice Address - Phone:865-769-4545
Practice Address - Fax:865-769-4501
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3651358Medicaid
TN4103266OtherBLUE CROSS BLUE SHIELD
3651358Medicare ID - Type Unspecified