Provider Demographics
NPI:1053774349
Name:DAVIS, JANE (PT, MSHP)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, MSHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 APRIL WIND DR S
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-5966
Mailing Address - Country:US
Mailing Address - Phone:936-524-3979
Mailing Address - Fax:
Practice Address - Street 1:64 APRIL WIND DR S
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-5966
Practice Address - Country:US
Practice Address - Phone:936-524-3979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-3699-42251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics