Provider Demographics
NPI:1821426073
Name:DAVIS, DANIELLE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BEVERLY CT
Mailing Address - Street 2:APT 5
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-3386
Mailing Address - Country:US
Mailing Address - Phone:732-991-5916
Mailing Address - Fax:
Practice Address - Street 1:2902 E WASHINGTON AVE
Practice Address - Street 2:WILLIAM BYRD HIGH SCHOOL
Practice Address - City:VINTON
Practice Address - State:VA
Practice Address - Zip Code:24179-1314
Practice Address - Country:US
Practice Address - Phone:540-890-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0126002050174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist