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General NPI Number Information
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NPI Number | 1780959387
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Entity Type | Individual
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Provider Name | COURTNEY D DAVIS LMT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 05/07/2012
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Provider Practice Location Address
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Address Line | 444 W MAIN ST STE 6
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City | CLARKSBURG
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State | WV
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Zip | 26301-2861
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Country | US
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Telephone | 304-677-2983
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Fax |
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Provider Business Mailing Address
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Address Line | 2091 GREEN AVE
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City | CLARKSBURG
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State | WV
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Zip | 26301-1567
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Country | US
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Telephone | 304-677-2983
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 2009-2643
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License Number State | WV
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