Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics |
NPI | 1174928840 |
---|---|
Provider Name | Lora Davis |
First Address | Chandler, AZ 85224-1686 |
Second Address | Chandler, AZ 85224-1686 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2014 |
Last Update Date | 13/02/2016 |