Provider Demographics
NPI:1558107532
Name:DAVIS, LORI ANN (PT)
Entity type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MOSSY OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:MS
Mailing Address - Zip Code:39560-9137
Mailing Address - Country:US
Mailing Address - Phone:601-757-0156
Mailing Address - Fax:
Practice Address - Street 1:19020 PINEVILLE RD STE 4
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:MS
Practice Address - Zip Code:39560-4572
Practice Address - Country:US
Practice Address - Phone:228-863-4080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist