MEDICARE: MRS. REAHSHELL LEIGH DAVIS RT(R), RDMS, RVT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2471C3402X	Radiography Radiologic Technologist	350594	TX

General Provider Information

NPI Number	:	1407876113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REAHSHELL LEIGH DAVIS RT(R), RDMS, RVT

Provider Business Mailing Address
First Line	:	PO BOX 731
Second Line	:
City	:	LEAKEY
State	:	TX
Zip	:	78873-0731
Country	:	US
Telephone Number	:	361-205-2230
Fax Number	:

Provider Business Practice Location Address
First Line	:	1069 SADDLE MOUNTAIN RD
Second Line	:
City	:	RIO FRIO
State	:	TX
Zip	:	78879
Country	:	US
Telephone Number	:	361-205-2230
Fax Number	:	361-000-0000

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/23/2019

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