Healthcare Provider Details

I. General information

NPI: 1316122864
Provider Name (Legal Business Name): RUTH ELLEN DAVISON LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 WEST SWANZEY RTE 10
SWANZEY NH
03446
US

IV. Provider business mailing address

PO BOX 644
WEST SWANZEY NH
03469-0644
US

V. Phone/Fax

Practice location:
  • Phone: 603-355-5241
  • Fax:
Mailing address:
  • Phone: 603-355-5241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1236M
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: