Provider Demographics
NPI:1790032779
Name:DAVIS, HEATHER L (LMT)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:L
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2048 WHITEHORN DR N
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3730
Mailing Address - Country:US
Mailing Address - Phone:719-650-4471
Mailing Address - Fax:719-531-0880
Practice Address - Street 1:1802 CHAPEL HILLS DR STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3736
Practice Address - Country:US
Practice Address - Phone:719-531-7188
Practice Address - Fax:719-531-0880
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist