Provider Demographics
NPI:1710474572
Name:DAVENPORT, ANNA LEIGH (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:LEIGH
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 WALLACE CIR
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-9060
Mailing Address - Country:US
Mailing Address - Phone:256-443-8237
Mailing Address - Fax:
Practice Address - Street 1:211 ANA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1768
Practice Address - Country:US
Practice Address - Phone:256-766-8963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTA8025225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant