Provider Demographics
NPI:1043393002
Name:DAVIS, LLOYD MICHAEL (LPT)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:MICHAEL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 N CONWAY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572
Mailing Address - Country:US
Mailing Address - Phone:956-581-6252
Mailing Address - Fax:956-581-6253
Practice Address - Street 1:2019 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2965
Practice Address - Country:US
Practice Address - Phone:956-581-6252
Practice Address - Fax:956-581-6253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1027357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ06504664Medicaid
TX650466Medicare PIN