Provider Demographics
NPI:1336316561
Name:DAVIS, THERESA FRANCES (RD)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:FRANCES
Last Name:DAVIS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:FRANCES
Other - Last Name:KOSMALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 MCGREGOR ST
Mailing Address - Street 2:CARDIAC REHAB, LEVEL D
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03102-3730
Mailing Address - Country:US
Mailing Address - Phone:603-663-6292
Mailing Address - Fax:603-663-8792
Practice Address - Street 1:100 MCGREGOR ST
Practice Address - Street 2:CARDIAC REHAB LEVEL D
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03102-3730
Practice Address - Country:US
Practice Address - Phone:603-663-6292
Practice Address - Fax:603-663-8792
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0515133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered