Provider Demographics
NPI:1598795338
Name:DAVENPORT, ALMA MARIE (PT)
Entity Type:Individual
Prefix:MS
First Name:ALMA
Middle Name:MARIE
Last Name:DAVENPORT
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 1:3810 PACKARD ST STE 100A
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2054
Mailing Address - Country:US
Mailing Address - Phone:734-482-5040
Mailing Address - Fax:
Practice Address - Street 1:3810 PACKARD ST STE 100A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2054
Practice Address - Country:US
Practice Address - Phone:734-482-5040
Practice Address - Fax:743-482-5084
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501009797174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist