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MACKENZIE DAVENPORT ATC

Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service Providers

Registrant NPI Number: 1427595842

Individual Registrant:
 MACKENZIE  DAVENPORT ATC
Gender: F
Not Sole Proprietor

Location and contact information for practice:
1000 RUSH DR  SALIDA, CO 81201-9627 US
Tel: 574-274-6598  Fax: --

Contact information for business:
PO BOX 531  PONCHA SPRINGS, CO 81242-0531 US
Tel: 574-274-6598  Fax: --

Registration Information:
NPI: 1427595842
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Specialist/Technologist
Athletic Trainer
IN36003148A
Y2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Specialist/Technologist
COAT.0002319

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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