Provider Demographics
NPI:1295858876
Name:DAVIS, JOHN PAUL (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PAUL
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 FRIENDSHIP CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:HONEA PATH
Mailing Address - State:SC
Mailing Address - Zip Code:29654-9103
Mailing Address - Country:US
Mailing Address - Phone:864-356-8716
Mailing Address - Fax:
Practice Address - Street 1:1404 ANDERSON ST
Practice Address - Street 2:#B
Practice Address - City:BELTON
Practice Address - State:SC
Practice Address - Zip Code:29627-2414
Practice Address - Country:US
Practice Address - Phone:864-356-8716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4962225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist