Provider Demographics
NPI:1790740751
Name:DAVIES, ALISSA KAY (PT, DPT, OCS, ATC/L)
Entity Type:Individual
Prefix:MS
First Name:ALISSA
Middle Name:KAY
Last Name:DAVIES
Suffix:
Gender:F
Credentials:PT, DPT, OCS, ATC/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 W BIG BEAVER RD STE 125
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-3915
Mailing Address - Country:US
Mailing Address - Phone:248-268-5742
Mailing Address - Fax:248-336-0144
Practice Address - Street 1:60 W BIG BEAVER RD STE 125
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-3915
Practice Address - Country:US
Practice Address - Phone:248-550-0147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010012622255A2300X
OHPT.013120225100000X
OHAT.24312255A2300X
MI5501015047225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer