MEDICARE: DENA M DAVIS LMT

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	225700000X	Massage Therapist	MT007353	GA

General Provider Information

NPI Number	:	1679828065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENA M DAVIS LMT

Provider Business Mailing Address
First Line	:	107 BAY CT
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-4332
Country	:	US
Telephone Number	:	478-595-8425
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 BAY CT
Second Line	:
City	:	WARNER ROBINS
State	:	GA
Zip	:	31088-4332
Country	:	US
Telephone Number	:	478-595-8425
Fax Number	:

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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