MEDICARE: MS. CAROL K DAVIS L.M.T.

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	171W00000X	Contractor	MT-2611P	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT-02611P	OTHER	AZ	ARIZONA MASSAGE THERAPY L

General Provider Information

NPI Number	:	1467651158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL K DAVIS L.M.T.

Provider Business Mailing Address
First Line	:	9601 W TIMBERLINE DR
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2922
Country	:	US
Telephone Number	:	623-876-8587
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 W TIMBERLINE DR
Second Line	:
City	:	SUN CITY
State	:	AZ
Zip	:	85351-2922
Country	:	US
Telephone Number	:	623-876-8587
Fax Number	:

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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