Provider Demographics
NPI:1558307850
Name:DAVIS, LYNNE A (PT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3555 NW 58TH ST
Mailing Address - Street 2:900
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-4707
Mailing Address - Country:US
Mailing Address - Phone:405-917-0418
Mailing Address - Fax:405-917-0419
Practice Address - Street 1:15500 JEFFERSONS GARDEN CT
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-1410
Practice Address - Country:US
Practice Address - Phone:405-826-8918
Practice Address - Fax:405-844-5535
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK1415225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ02757Medicare UPIN