Provider Demographics
NPI:1467651158
Name:DAVIS, CAROL K (LMT)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:K
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 W TIMBERLINE DR
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85351-2922
Mailing Address - Country:US
Mailing Address - Phone:623-876-8587
Mailing Address - Fax:
Practice Address - Street 1:9601 W TIMBERLINE DR
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-2922
Practice Address - Country:US
Practice Address - Phone:623-876-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-2611P171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMT-02611POtherARIZONA MASSAGE THERAPY L