Provider Demographics
NPI:1407162035
Name:DAVIS, TRICIA ELIZABETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:ELIZABETH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:TRICIA
Other - Middle Name:E
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:1945 SCOTSVILLE ROAD
Mailing Address - Street 2:B2 PMB356
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:270-842-8824
Mailing Address - Fax:270-842-7917
Practice Address - Street 1:5782 ADAMS AVENUE PARKWAY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405
Practice Address - Country:US
Practice Address - Phone:801-917-8000
Practice Address - Fax:801-917-8001
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT349228-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist