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General NPI Number Information
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NPI Number | 1790740751
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Entity Type | Individual
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Provider Name | ALISSA KAY DAVIES PT, DPT, OCS, ATC/L
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 07/21/2024
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Provider Practice Location Address
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Address Line | 44038 WOODWARD AVE STE 101
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City | BLOOMFIELD HILLS
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State | MI
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Zip | 48302-5036
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Country | US
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Telephone | 248-246-2301
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Fax |
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Provider Business Mailing Address
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Address Line | 2410 STARR RD
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City | ROYAL OAK
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State | MI
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Zip | 48073-2208
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Country | US
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Telephone | 309-255-4839
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2601001262
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501015047
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License Number State | MI
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