Provider Demographics
NPI:1104287218
Name:DAVIS, LINDSEY MARIE (MHA, ATC, LAT)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MHA, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20615 STERLING BAY LN W APT N
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4930
Mailing Address - Country:US
Mailing Address - Phone:973-650-0476
Mailing Address - Fax:
Practice Address - Street 1:209 RIDGE RD # 5000
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-0407
Practice Address - Country:US
Practice Address - Phone:704-894-2223
Practice Address - Fax:704-894-2802
Is Sole Proprietor?:No
Enumeration Date:2016-03-16
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0062652255A2300X
NJ25MT002138002255A2300X
NC49632255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer