Provider Demographics
NPI:1093537680
Name:DAVIDSON, DAVID ALLEN II (LMT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ALLEN
Last Name:DAVIDSON
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1140
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-1140
Mailing Address - Country:US
Mailing Address - Phone:808-873-0733
Mailing Address - Fax:808-873-9646
Practice Address - Street 1:95 LONO AVE STE 105
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-1610
Practice Address - Country:US
Practice Address - Phone:808-873-0733
Practice Address - Fax:808-873-9646
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-25
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMAT-17792225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist