Provider Demographics
NPI:1699923813
Name:DAVIS, RITA K
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3907 CARATOKE HWY
Mailing Address - Street 2:
Mailing Address - City:BARCO
Mailing Address - State:NC
Mailing Address - Zip Code:27917-9500
Mailing Address - Country:US
Mailing Address - Phone:252-457-0532
Mailing Address - Fax:252-457-0540
Practice Address - Street 1:3907 CARATOKE HWY
Practice Address - Street 2:
Practice Address - City:BARCO
Practice Address - State:NC
Practice Address - Zip Code:27917-9500
Practice Address - Country:US
Practice Address - Phone:252-457-0532
Practice Address - Fax:252-457-0540
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2008-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1844225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant