Provider Demographics
NPI:1487655205
Name:DAVISON, NANCY L (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:L
Last Name:DAVISON
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:PO BOX 3450
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3450
Mailing Address - Country:US
Mailing Address - Phone:775-882-2211
Mailing Address - Fax:
Practice Address - Street 1:3430 EXECUTIVE POINTE WAY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-7946
Practice Address - Country:US
Practice Address - Phone:775-882-2211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1839225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100038Medicare ID - Type Unspecified