Provider Demographics
NPI:1841614310
Name:DAVIS, ALICE LOUISE (LMT, MMP, AMMP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LOUISE
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT, MMP, AMMP
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 5516
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76902-5516
Mailing Address - Country:US
Mailing Address - Phone:325-374-7735
Mailing Address - Fax:325-657-8484
Practice Address - Street 1:1201 S ABE ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-7243
Practice Address - Country:US
Practice Address - Phone:325-374-7735
Practice Address - Fax:325-657-8484
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-04
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109788225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist