Healthcare Provider Details

I. General information

NPI: 1760391916
Provider Name (Legal Business Name): SUSAN LYNN DAVENPORT MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 HAMPDEN DR
LANSING MI
48911-1785
US

IV. Provider business mailing address

1921 YUMA TRL
OKEMOS MI
48864-2744
US

V. Phone/Fax

Practice location:
  • Phone: 517-755-1160
  • Fax:
Mailing address:
  • Phone: 517-755-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501009998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: