Provider Demographics
NPI:1063534071
Name:DAVIS, VINCY
Entity type:Individual
Prefix:
First Name:VINCY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:VINCY
Other - Middle Name:
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPT
Mailing Address - Street 1:17575 DEVONSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7612
Mailing Address - Country:US
Mailing Address - Phone:734-624-0111
Mailing Address - Fax:734-556-1530
Practice Address - Street 1:17575 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7612
Practice Address - Country:US
Practice Address - Phone:734-624-0111
Practice Address - Fax:734-556-1530
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004868225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist