Provider Demographics
NPI:1427448463
Name:DAVIS, MARY (LMT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26085 AMY CIR
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-6113
Mailing Address - Country:US
Mailing Address - Phone:720-244-7217
Mailing Address - Fax:
Practice Address - Street 1:28186 HIGHWAY 74
Practice Address - Street 2:UNIT 7
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-5775
Practice Address - Country:US
Practice Address - Phone:720-244-7217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0004270225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist