Provider Demographics
NPI:1780811026
Name:DAVIS, TERRIE (LMT)
Entity type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 MAIN ST
Mailing Address - Street 2:SIUTE 201
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-1155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:72 MAIN ST
Practice Address - Street 2:SIUTE 201
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1155
Practice Address - Country:US
Practice Address - Phone:802-877-6362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-13
Last Update Date:2009-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT029916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist