Provider Demographics
NPI:1467042127
Name:DAVIS, ALLISON LEEANN
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:LEEANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-4137
Mailing Address - Country:US
Mailing Address - Phone:704-776-8886
Mailing Address - Fax:
Practice Address - Street 1:10506 CLEAR CREEK COMMERCE DR
Practice Address - Street 2:
Practice Address - City:MINT HILL
Practice Address - State:NC
Practice Address - Zip Code:28227-7078
Practice Address - Country:US
Practice Address - Phone:704-545-2377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA7334225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant