Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 669 | AK |
N | 226300000X | Kinesiotherapist |
NPI | 1164564043 |
---|---|
Provider Name | Ms. Morgan Humphreys Davis |
First Address | Juneau, AK 99801 |
Second Address | Juneau, AK 99801-1186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 24/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT18241 | (05) | AK |