Healthcare Provider Details

I. General information

NPI: 1790740751
Provider Name (Legal Business Name): ALISSA KAY DAVIES PT, DPT, OCS, ATC/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 07/21/2024
Certification Date: 07/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44038 WOODWARD AVE STE 101
BLOOMFIELD HILLS MI
48302-5036
US

IV. Provider business mailing address

2410 STARR RD
ROYAL OAK MI
48073-2208
US

V. Phone/Fax

Practice location:
  • Phone: 248-246-2301
  • Fax:
Mailing address:
  • Phone: 309-255-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601001262
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501015047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: