Provider Demographics
NPI:1053947382
Name:DAVIS, JON BARRY (PT)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:BARRY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 WADE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSBURY
Mailing Address - State:TX
Mailing Address - Zip Code:78638-1642
Mailing Address - Country:US
Mailing Address - Phone:830-708-2416
Mailing Address - Fax:
Practice Address - Street 1:1129 WADE RD
Practice Address - Street 2:
Practice Address - City:KINGSBURY
Practice Address - State:TX
Practice Address - Zip Code:78638-1642
Practice Address - Country:US
Practice Address - Phone:830-708-2416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101590225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist