Provider Demographics
NPI:1063855187
Name:DAVIS-PADDOCK, LINZIE ANN
Entity Type:Individual
Prefix:
First Name:LINZIE
Middle Name:ANN
Last Name:DAVIS-PADDOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 KING ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29401-1441
Mailing Address - Country:US
Mailing Address - Phone:843-789-3581
Mailing Address - Fax:
Practice Address - Street 1:310 KING ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1441
Practice Address - Country:US
Practice Address - Phone:843-789-3581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC89960172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist