Provider Demographics
NPI:1386657898
Name:DAVIS, KATHYRN S (PT)
Entity Type:Individual
Prefix:
First Name:KATHYRN
Middle Name:S
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 1:2426 NARROW GAUGE RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-7717
Mailing Address - Country:US
Mailing Address - Phone:336-349-4702
Mailing Address - Fax:
Practice Address - Street 1:281 DOVE RD
Practice Address - Street 2:
Practice Address - City:RUFFIN
Practice Address - State:NC
Practice Address - Zip Code:27326-8936
Practice Address - Country:US
Practice Address - Phone:336-939-3312
Practice Address - Fax:336-939-7789
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1997225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7227867Medicaid