Healthcare Provider Details

I. General information

NPI: 1053536730
Provider Name (Legal Business Name): KIMBERLY ANNE DAVIS MSPT, ATP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 REGIONAL DR SUITE #7
CONCORD NH
03301-8518
US

IV. Provider business mailing address

57 REGIONAL DR SUITE #7
CONCORD NH
03301-8518
US

V. Phone/Fax

Practice location:
  • Phone: 603-226-2900
  • Fax: 603-226-2907
Mailing address:
  • Phone: 603-226-2900
  • Fax: 603-226-2907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2394
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: