Provider Demographics
NPI:1265429393
Name:DAVIS, SHAWN A (DPT)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N WOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4038
Mailing Address - Country:US
Mailing Address - Phone:908-936-8700
Mailing Address - Fax:908-936-8701
Practice Address - Street 1:822 N WOOD AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4038
Practice Address - Country:US
Practice Address - Phone:908-925-9700
Practice Address - Fax:908-663-2551
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00755700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ023612MWSMedicare ID - Type UnspecifiedPHYSICAL THERAPIST
NJ091356UCZMedicare ID - Type UnspecifiedPHYSICAL THERAPIST