Provider Demographics
NPI:1376137406
Name:DAVIS, DARIA (PTA)
Entity Type:Individual
Prefix:
First Name:DARIA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMMONS LOOP STE 100
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1904
Mailing Address - Country:US
Mailing Address - Phone:406-752-7250
Mailing Address - Fax:406-752-6250
Practice Address - Street 1:175 COMMONS LOOP STE 100
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1904
Practice Address - Country:US
Practice Address - Phone:406-752-7250
Practice Address - Fax:406-752-6250
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPTP-PTA-LIC-19451225100000X, 225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist