Basic Information
| Provider Information | |||||||||
| NPI: | 1053536730 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAVIS | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSPT, ATP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 57 REGIONAL DR | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | 6032262907 | ||||||||
| Practice Location | |||||||||
| Address1: | 57 REGIONAL DR | ||||||||
| Address2: | SUITE #7 | ||||||||
| City: | CONCORD | ||||||||
| State: | NH | ||||||||
| PostalCode: | 033018518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6032262900 | ||||||||
| FaxNumber: | 6032262907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2007 | ||||||||
| LastUpdateDate: | 09/30/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2394 | NH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.