Provider Demographics
NPI:1790047561
Name:DAVIS, DANA (LMT)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 390685
Mailing Address - Street 2:
Mailing Address - City:KEAUHOU
Mailing Address - State:HI
Mailing Address - Zip Code:96739-0685
Mailing Address - Country:US
Mailing Address - Phone:808-895-6137
Mailing Address - Fax:
Practice Address - Street 1:75-5995 KUAKINI HWY STE 603
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-2124
Practice Address - Country:US
Practice Address - Phone:808-895-6137
Practice Address - Fax:808-731-4577
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2023-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI8157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist