1942278288 NPI number — MRS. KAREN MONICA DAVIS MPT ATC

Table of content: MRS. KAREN MONICA DAVIS MPT ATC (NPI 1942278288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942278288 NPI number — MRS. KAREN MONICA DAVIS MPT ATC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAVIS
Provider First Name:
KAREN
Provider Middle Name:
MONICA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MPT ATC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942278288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 CROSS TIMBERS RD
Provider Second Line Business Mailing Address:
STE 1100
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75028
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-691-1331
Provider Business Mailing Address Fax Number:
972-691-1731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 CROSS TIMBERS RD
Provider Second Line Business Practice Location Address:
STE 1100
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-691-1331
Provider Business Practice Location Address Fax Number:
972-691-1731
Provider Enumeration Date:
03/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1156630 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8T2860 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com