Provider Demographics
NPI:1750524567
Name:DAVIS, DIANA MARGARET (MSPT)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:MARGARET
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 NORTHWESTERN DR
Mailing Address - Street 2:STE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1156
Mailing Address - Country:US
Mailing Address - Phone:915-875-1559
Mailing Address - Fax:915-877-9357
Practice Address - Street 1:1845 NORTHWESTERN DR
Practice Address - Street 2:STE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1156
Practice Address - Country:US
Practice Address - Phone:915-875-1559
Practice Address - Fax:915-877-9357
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1182179225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist