Provider Demographics
NPI:1154585750
Name:DAVIS, ELIZABETH KIDD (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KIDD
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 RAVEN RD UNIT 106
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6774
Mailing Address - Country:US
Mailing Address - Phone:919-548-3251
Mailing Address - Fax:
Practice Address - Street 1:833 N SMITHFIELD RD
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7717
Practice Address - Country:US
Practice Address - Phone:919-266-4482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist