Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | A04160 | KY |
Y | 225200000X | Physical Therapy Assistant | A04160 | KY |
NPI | 1003498700 |
---|---|
Provider Name | Ms. Alisha Davis |
First Address | Louisville, KY 40222-6308 |
Second Address | Louisville, KY 40222-6308 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2021 |
Last Update Date | 23/04/2021 |