Provider Demographics
NPI:1235520487
Name:DAVIS, DEBORAH JUANITA (LMT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JUANITA
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 1:14523 MERRY MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-4319
Mailing Address - Country:US
Mailing Address - Phone:832-794-3377
Mailing Address - Fax:
Practice Address - Street 1:14523 MERRY MEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-4319
Practice Address - Country:US
Practice Address - Phone:832-794-3377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT115020225700000X
TXMI2830225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist