Provider Demographics
NPI:1861007809
Name:DAVIS, DANIELLE (LMT, CPT)
Entity Type:Individual
Prefix:MRS
First Name:DANIELLE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT, CPT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:
Other - Last Name:TEWMEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:305 GERARD AVE
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-5465
Mailing Address - Country:US
Mailing Address - Phone:813-351-0850
Mailing Address - Fax:
Practice Address - Street 1:305 GERARD AVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-5465
Practice Address - Country:US
Practice Address - Phone:813-351-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83095225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist