Provider Demographics
NPI:1700849882
Name:DAVEY, MATTHEW JOSEPH (ATC, CSCS)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:JOSEPH
Last Name:DAVEY
Suffix:
Gender:M
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 J ST
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2320
Mailing Address - Country:US
Mailing Address - Phone:530-750-7939
Mailing Address - Fax:
Practice Address - Street 1:1970 LAKE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5663
Practice Address - Country:US
Practice Address - Phone:530-753-9355
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer