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General NPI Number Information
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NPI Number | 1679972889
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Entity Type | Individual
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Provider Name | AMANDA MICHELLE DAVIS DPT, PRPC
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Gender | Female
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Dates
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Enumeration Date | 08/14/2014
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 1 BOONE RD
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City | BREMERTON
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State | WA
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Zip | 98312-1894
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Country | US
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Telephone | 360-475-4218
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Fax |
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Provider Business Mailing Address
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Address Line | 56 GOLD CREEK RD NW
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City | BREMERTON
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State | WA
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Zip | 98312-9649
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Country | US
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Telephone | 360-620-0691
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60471306
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License Number State | WA
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