Provider Demographics
NPI:1376747345
Name:DAVIS, KERI ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4450 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-5403
Mailing Address - Country:US
Mailing Address - Phone:832-978-3313
Mailing Address - Fax:
Practice Address - Street 1:4225 LAKE ARTHUR DR
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-6490
Practice Address - Country:US
Practice Address - Phone:409-727-3193
Practice Address - Fax:409-722-0714
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1156807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist