Provider Demographics
NPI:1982248043
Name:DAVIS, ANNAMARIA (MA60939280)
Entity type:Individual
Prefix:
First Name:ANNAMARIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA60939280
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N BERNARD ST APT 300
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-0231
Mailing Address - Country:US
Mailing Address - Phone:509-690-8694
Mailing Address - Fax:
Practice Address - Street 1:417 W 1ST AVE STE 1B
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-6001
Practice Address - Country:US
Practice Address - Phone:509-747-9999
Practice Address - Fax:509-835-4444
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60939280225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist