Provider Demographics
NPI:1184141640
Name:DAVIES, DAN PAUL (ATC, CSCS, MED)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:PAUL
Last Name:DAVIES
Suffix:
Gender:M
Credentials:ATC, CSCS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 COLLEGE STA
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-8490
Mailing Address - Country:US
Mailing Address - Phone:207-725-3018
Mailing Address - Fax:207-798-7043
Practice Address - Street 1:9000 COLLEGE STA
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-8490
Practice Address - Country:US
Practice Address - Phone:207-725-3018
Practice Address - Fax:207-798-7043
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAT2392083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7895OtherCOLLEGE