Healthcare Provider Details

I. General information

NPI: 1720471329
Provider Name (Legal Business Name): ELIZABETH ANNE DAVIS ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 UNIVERSITY DR ATHLETIC DEPARTMENT
BILLINGS MT
59101-0245
US

IV. Provider business mailing address

945 VENICE BEACH WAY UNIT 4
BILLINGS MT
59106-2490
US

V. Phone/Fax

Practice location:
  • Phone: 406-657-2375
  • Fax:
Mailing address:
  • Phone: 406-589-6163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number2000007791
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: