Provider Demographics
NPI:1558669069
Name:DAVIS, CATHLYN MENDOZA (NBC-HWC)
Entity Type:Individual
Prefix:MRS
First Name:CATHLYN
Middle Name:MENDOZA
Last Name:DAVIS
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 SWEET AUTUMN ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3575
Mailing Address - Country:US
Mailing Address - Phone:757-748-6136
Mailing Address - Fax:
Practice Address - Street 1:323 SWEET AUTUMN ARCH
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3575
Practice Address - Country:US
Practice Address - Phone:757-748-6136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306601986225200000X
VAA-3815120171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171400000XOther Service ProvidersHealth & Wellness CoachGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant