Provider Demographics
NPI:1073102323
Name:DAVIS, PAMELA RAE (LMT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:RAE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:925 W BASELINE RD STE 105-264
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1100
Mailing Address - Country:US
Mailing Address - Phone:480-466-7473
Mailing Address - Fax:480-945-5339
Practice Address - Street 1:5235 S KYRENE RD STE 203
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1762
Practice Address - Country:US
Practice Address - Phone:480-466-7473
Practice Address - Fax:480-945-5339
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ02480P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist