Provider Demographics
NPI:1104047737
Name:DAVIS, KAYTLEN ANNE (PT)
Entity type:Individual
Prefix:MRS
First Name:KAYTLEN
Middle Name:ANNE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KAYTLEN
Other - Middle Name:ANNE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:86 MAIN ST UNIT 204A
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-5853
Mailing Address - Country:US
Mailing Address - Phone:207-333-5022
Mailing Address - Fax:207-333-5089
Practice Address - Street 1:86 MAIN ST UNIT 204A
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5853
Practice Address - Country:US
Practice Address - Phone:207-333-5022
Practice Address - Fax:207-333-5089
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT3058261QP2000X, 225100000X
ME3058174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No174400000XOther Service ProvidersSpecialist