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NPI Code Detail

MEDICARE: RICHARD DAVIS LMP

MEDICARE: RICHARD DAVIS LMP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage TherapistMA 60284327WA

General Provider Information

NPI Number : 1275886020
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD DAVIS LMP
Provider Business Mailing Address
First Line : 18300 JOHNSON RD
Second Line :
City : CLATSKANIE
State : OR
Zip : 97016-2611
Country : US
Telephone Number : 503-728-9604
Fax Number :
Provider Business Practice Location Address
First Line : 831 12TH AVE
Second Line :
City : LONGVIEW
State : WA
Zip : 98632-2403
Country : US
Telephone Number : 360-636-2470
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2012
Last Update Date : 10/17/2012

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