Provider Demographics
NPI:1992947659
Name:DAVIS, ROSHAN DENISE
Entity type:Individual
Prefix:
First Name:ROSHAN
Middle Name:DENISE
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 1:707 LAMAR AVE. STE. M
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-4460
Mailing Address - Country:US
Mailing Address - Phone:903-785-7528
Mailing Address - Fax:903-785-1870
Practice Address - Street 1:707 LAMAR AVE. STE. M
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-4460
Practice Address - Country:US
Practice Address - Phone:903-785-7528
Practice Address - Fax:903-785-1870
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT108456225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist