Provider Demographics
NPI:1750842639
Name:DAVIS, CHRISTINA N (LMP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:N
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12416 94TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2765
Mailing Address - Country:US
Mailing Address - Phone:520-838-1600
Mailing Address - Fax:206-297-6118
Practice Address - Street 1:7621 AURORA AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4749
Practice Address - Country:US
Practice Address - Phone:206-588-1061
Practice Address - Fax:206-297-6118
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60944493225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty