Provider Demographics
NPI:1629686407
Name:MCDAVITT, CARMEN MARIE (CMT, NMT)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:MARIE
Last Name:MCDAVITT
Suffix:
Gender:F
Credentials:CMT, NMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 ARROWROOT CIR
Mailing Address - Street 2:
Mailing Address - City:ANTELOPE
Mailing Address - State:CA
Mailing Address - Zip Code:95843-3725
Mailing Address - Country:US
Mailing Address - Phone:913-731-0722
Mailing Address - Fax:
Practice Address - Street 1:5714 LONETREE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-3734
Practice Address - Country:US
Practice Address - Phone:916-259-2510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist