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General NPI Number Information
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NPI Number | 1902235146
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Entity Type | Individual
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Provider Name | KELLY NICOLE DAVIS DPT, ATC, COMT, CSCS
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Gender | Female
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 1761 PINEHURST PLZ
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City | PALM SPRINGS
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State | CA
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Zip | 92264-3889
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Country | US
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Telephone | 610-256-2860
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Fax |
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Provider Business Mailing Address
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Address Line | 1761 PINEHURST PLZ
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City | PALM SPRINGS
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State | CA
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Zip | 92264-3889
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Country | US
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Telephone | 610-256-2860
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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 | PT 28657
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL 3707
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 299323
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License Number State | CA
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