Provider Demographics
NPI:1295029536
Name:DAVIDSON, ANNAMIEKA HOPPS (LMT)
Entity Type:Individual
Prefix:MRS
First Name:ANNAMIEKA
Middle Name:HOPPS
Last Name:DAVIDSON
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 1:2815 SE 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-1310
Mailing Address - Country:US
Mailing Address - Phone:541-556-9208
Mailing Address - Fax:
Practice Address - Street 1:2933 SE 20TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-2234
Practice Address - Country:US
Practice Address - Phone:503-208-5331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18137225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist