Provider Demographics
NPI:1720537509
Name:DAVIS, RHIANNON LEIGH (PTA)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:LEIGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 KIMBERLY LN APT 10
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05676-7003
Mailing Address - Country:US
Mailing Address - Phone:267-608-7951
Mailing Address - Fax:
Practice Address - Street 1:191 KIMBERLY LN APT 10
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:VT
Practice Address - Zip Code:05676-7003
Practice Address - Country:US
Practice Address - Phone:267-608-7951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0013749225200000X
VT041.0133901225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant