Provider Demographics
NPI:1235491481
Name:DAVIS, TALEKA DARVELL (LMP)
Entity Type:Individual
Prefix:MRS
First Name:TALEKA
Middle Name:DARVELL
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 140TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2975
Mailing Address - Country:US
Mailing Address - Phone:425-957-0761
Mailing Address - Fax:425-957-1156
Practice Address - Street 1:1140 140TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2975
Practice Address - Country:US
Practice Address - Phone:425-957-0761
Practice Address - Fax:425-957-1156
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60288209172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist