Provider Demographics
NPI:1225420508
Name:DAVIS, MICHELLE LYNETTE (ATC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNETTE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4912 SUMMER GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-3991
Mailing Address - Country:US
Mailing Address - Phone:480-282-2663
Mailing Address - Fax:
Practice Address - Street 1:3000 NEWELL DR
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-1279
Practice Address - Country:US
Practice Address - Phone:480-282-2663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer