1962477620 NPI number — MRS. ARIANNE MARIE DAVIS LAT, ATC

Table of content: MRS. ARIANNE MARIE DAVIS LAT, ATC (NPI 1962477620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962477620 NPI number — MRS. ARIANNE MARIE DAVIS LAT, ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
ARIANNE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAT, ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962477620
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
204 SUMMER HAVEN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOWING ROCK
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28605-9414
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-295-8451
Provider Business Mailing Address Fax Number:
828-295-8451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 MAIN ST
Provider Second Line Business Practice Location Address:
CPO 3730
Provider Business Practice Location Address City Name:
BANNER ELK
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-898-8892
Provider Business Practice Location Address Fax Number:
828-898-8742
Provider Enumeration Date:
02/17/2006

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: 2255A2300X , with the licence number:  0910 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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