Provider Demographics
NPI:1831959535
Name:DAVIS, CONNIE ANN
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 SYDNEY LN UNIT 101
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4670
Mailing Address - Country:US
Mailing Address - Phone:706-662-8379
Mailing Address - Fax:
Practice Address - Street 1:1852 TRAWOOD DR STE C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3106
Practice Address - Country:US
Practice Address - Phone:706-662-8379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist