Provider Demographics
NPI:1386168128
Name:DAVIES, ANNELISE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:ANNELISE
Middle Name:
Last Name:DAVIES
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 PECAN ST APT 47
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70401-2373
Mailing Address - Country:US
Mailing Address - Phone:215-284-4226
Mailing Address - Fax:985-549-2511
Practice Address - Street 1:500 W UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70401-1304
Practice Address - Country:US
Practice Address - Phone:985-549-2200
Practice Address - Fax:985-549-2511
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAATH.2005062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer