MEDICARE: SETH DAVIS

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
1	225700000X	Massage Therapist	8681	CO

General Provider Information

NPI Number	:	1346626314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SETH DAVIS

Provider Business Mailing Address
First Line	:	2600 S OAKHURST CT
Second Line	:	#7
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-4489
Country	:	US
Telephone Number	:	970-946-4812
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 8TH ST
Second Line	:	#303
City	:	GLENWOOD SPRINGS
State	:	CO
Zip	:	81601-3326
Country	:	US
Telephone Number	:	970-946-4812
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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Directions to “ SETH DAVIS ” Practice Location

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