Provider Demographics
NPI:1487921813
Name:DAVIS, WESLEY C (DPT)
Entity type:Individual
Prefix:
First Name:WESLEY
Middle Name:C
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 1:12940 HATCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-6002
Mailing Address - Country:US
Mailing Address - Phone:814-282-0589
Mailing Address - Fax:
Practice Address - Street 1:9108 STATE HIGHWAY 198
Practice Address - Street 2:
Practice Address - City:CONNEAUTVILLE
Practice Address - State:PA
Practice Address - Zip Code:16406-2646
Practice Address - Country:US
Practice Address - Phone:814-587-2012
Practice Address - Fax:814-587-2350
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT021260225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist