1407162035 NPI number — MRS. TRICIA ELIZABETH DAVIS P.T.

Table of content: MRS. TRICIA ELIZABETH DAVIS P.T. (NPI 1407162035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407162035 NPI number — MRS. TRICIA ELIZABETH DAVIS P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
TRICIA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MOONEY
Provider Other First Name:
TRICIA
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHYSICAL THERAPIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1407162035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 SCOTSVILLE ROAD
Provider Second Line Business Mailing Address:
B2 PMB356
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-842-8824
Provider Business Mailing Address Fax Number:
270-842-7917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5782 ADAMS AVENUE PARKWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OGDEN
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-917-8000
Provider Business Practice Location Address Fax Number:
801-917-8001
Provider Enumeration Date:
08/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  349228-2401 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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