Provider Demographics
NPI:1639414675
Name:DAVIS, EVELYN D (LMT, MMT)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT, MMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 INDEPENDENCE PKWY STE 318
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5471
Mailing Address - Country:US
Mailing Address - Phone:469-831-9652
Mailing Address - Fax:
Practice Address - Street 1:5501 INDEPENDENCE PKWY STE 318
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5471
Practice Address - Country:US
Practice Address - Phone:469-831-9652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-03
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT123347225700000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist