Provider Demographics
NPI:1922032374
Name:DAVENPORT, PATRICIA L (ATC)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1493 NORTHWOOD DR APT 203
Mailing Address - Street 2:
Mailing Address - City:MOSCOW
Mailing Address - State:ID
Mailing Address - Zip Code:83843-9397
Mailing Address - Country:US
Mailing Address - Phone:509-432-9845
Mailing Address - Fax:
Practice Address - Street 1:WASHINGTON STATE UNIVERSITY
Practice Address - Street 2:BOHLER ATHLETIC COMPLEX M-4K
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-1602
Practice Address - Country:US
Practice Address - Phone:509-335-8936
Practice Address - Fax:506-335-4729
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer