Provider Demographics
NPI:1679031504
Name:DAVIS, CARLY (DPT)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:SCHMALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:2707 VINE ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1907
Mailing Address - Country:US
Mailing Address - Phone:785-628-2105
Mailing Address - Fax:785-628-2165
Practice Address - Street 1:2707 VINE ST STE 1
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1907
Practice Address - Country:US
Practice Address - Phone:785-628-2105
Practice Address - Fax:785-628-2165
Is Sole Proprietor?:No
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist