Provider Demographics
NPI:1023247392
Name:DAVIS, MARY ANN (PTA)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 RIVERBEND APARTMENTS RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26301-4152
Mailing Address - Country:US
Mailing Address - Phone:304-695-0351
Mailing Address - Fax:
Practice Address - Street 1:23 RIVERBEND APARTMENTS RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:WV
Practice Address - Zip Code:26301-4152
Practice Address - Country:US
Practice Address - Phone:304-695-0351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1389225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant