Provider Demographics
NPI:1164564043
Name:DAVIS, MORGAN HUMPHREYS (PT)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:HUMPHREYS
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 N. FRANKLIN ST.
Mailing Address - Street 2:SUITE 305
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-523-1110
Mailing Address - Fax:907-523-1136
Practice Address - Street 1:431 N FRANKLIN STREET
Practice Address - Street 2:SUITE 305
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1186
Practice Address - Country:US
Practice Address - Phone:907-523-1110
Practice Address - Fax:907-523-1136
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK669225100000X
226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPT18241Medicaid
AKK161544Medicare PIN