Basic Information
| Provider Information | |||||||||
| NPI: | 1265197800 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | COLTON | ||||||||
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| Mailing Information | |||||||||
| Address1: | 204 COUNTY ROAD 296 | ||||||||
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| City: | HILLSBORO | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356433241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2564765993 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1241 PT MALLARD PKWY STE 201 | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356016555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563509750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2021 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | PTA9454 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.