Provider Demographics
NPI:1487209854
Name:DAVIES, KATHY NATACHA
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:NATACHA
Last Name:DAVIES
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 1:24 CHICAGO CT
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-5800
Mailing Address - Country:US
Mailing Address - Phone:516-526-7030
Mailing Address - Fax:631-647-8948
Practice Address - Street 1:110 BI COUNTY BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-3943
Practice Address - Country:US
Practice Address - Phone:516-526-7030
Practice Address - Fax:631-647-8948
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019294225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist