Provider Demographics
NPI:1336232727
Name:DAVIS, YVONNE MAUREEN (PT)
Entity Type:Individual
Prefix:MS
First Name:YVONNE
Middle Name:MAUREEN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 SHOREVIEW LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5059
Mailing Address - Country:US
Mailing Address - Phone:281-684-6164
Mailing Address - Fax:281-499-0746
Practice Address - Street 1:3622 SHOREVIEW LN
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-5059
Practice Address - Country:US
Practice Address - Phone:281-684-6164
Practice Address - Fax:281-499-0746
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098556225100000X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX108038401Medicaid
TX108038403Medicaid