Provider Demographics
NPI:1093078206
Name:DAVIS, RHONDA KAYE (LMT)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:KAYE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 1/2 4TH ST
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-4460
Mailing Address - Country:US
Mailing Address - Phone:208-798-5420
Mailing Address - Fax:208-798-5430
Practice Address - Street 1:3316 1/2 4TH ST
Practice Address - Street 2:SUITE 4A
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-4460
Practice Address - Country:US
Practice Address - Phone:208-798-5420
Practice Address - Fax:208-798-5430
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist