Provider Demographics
NPI:1083280531
Name:DAVENPORT, TORREY (DPT)
Entity Type:Individual
Prefix:
First Name:TORREY
Middle Name:
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 EASTERN SKY DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-7351
Mailing Address - Country:US
Mailing Address - Phone:231-932-9014
Mailing Address - Fax:231-932-9034
Practice Address - Street 1:2164 ARTHUR CT
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49685-7977
Practice Address - Country:US
Practice Address - Phone:810-423-3794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501020047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist