MEDICARE: ANGELA DAVIS L.M.P.

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	MA00024015	WA

General Provider Information

NPI Number	:	1568670016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA DAVIS L.M.P.

Provider Business Mailing Address
First Line	:	15406 NE 47TH CIR
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98682-6093
Country	:	US
Telephone Number	:	360-635-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	8221 NE HAZEL DELL AVE
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-8153
Country	:	US
Telephone Number	:	360-635-3771
Fax Number	:

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

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	11/05/2008

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