Provider Demographics
NPI:1598982852
Name:DAVIS, TETYANA M (LMT)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:M
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:781 BETA DR
Mailing Address - Street 2:SUITE K
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2356
Mailing Address - Country:US
Mailing Address - Phone:216-374-2138
Mailing Address - Fax:
Practice Address - Street 1:781 BETA DR
Practice Address - Street 2:SUITE K
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2356
Practice Address - Country:US
Practice Address - Phone:216-374-2138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33015203225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist