Provider Demographics
NPI:1790940542
Name:DAVIS, NICCETA (PT, PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:NICCETA
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT, PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1664 NARANJO CT
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-2789
Mailing Address - Country:US
Mailing Address - Phone:909-794-4244
Mailing Address - Fax:
Practice Address - Street 1:1664 NARANJO CT
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-2789
Practice Address - Country:US
Practice Address - Phone:909-794-4244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9150225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist