Provider Demographics
NPI:1992949655
Name:DAVIS, AMY LANELLE (PT)
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LANELLE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:75-1029 HENRY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1666
Mailing Address - Country:US
Mailing Address - Phone:808-334-0806
Mailing Address - Fax:808-334-0483
Practice Address - Street 1:75-1029 HENRY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-1666
Practice Address - Country:US
Practice Address - Phone:808-334-0806
Practice Address - Fax:808-334-0483
Is Sole Proprietor?:No
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist