Provider Demographics
NPI:1063546901
Name:DAVIS, ROBERT T (MS, LAC)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:T
Last Name:DAVIS
Suffix:
Gender:M
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 TIMBER LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403
Mailing Address - Country:US
Mailing Address - Phone:802-862-8880
Mailing Address - Fax:802-862-8887
Practice Address - Street 1:39 TIMBER LANE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403
Practice Address - Country:US
Practice Address - Phone:802-862-8880
Practice Address - Fax:802-862-8887
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT091-0000072171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT030362348OtherFEDERAL TAX ID