Provider Demographics
NPI:1740061167
Name:BEVILACQUA-DAVISON, ROSANA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:ROSANA
Middle Name:
Last Name:BEVILACQUA-DAVISON
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14028 US-183
Mailing Address - Street 2:ST # 120
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717
Mailing Address - Country:US
Mailing Address - Phone:512-580-5808
Mailing Address - Fax:
Practice Address - Street 1:14028 N HWY 183
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5992
Practice Address - Country:US
Practice Address - Phone:512-580-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT116480225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist