Provider Demographics
NPI:1346626314
Name:DAVIS, SETH
Entity Type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S OAKHURST CT
Mailing Address - Street 2:#7
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4489
Mailing Address - Country:US
Mailing Address - Phone:970-946-4812
Mailing Address - Fax:
Practice Address - Street 1:214 8TH ST
Practice Address - Street 2:#303
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3326
Practice Address - Country:US
Practice Address - Phone:970-946-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist