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MACKENZIE DAVENPORT ATC
Athletic Trainer >> Specialist/Technologist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1427595842
Individual Registrant: MACKENZIE DAVENPORT ATC
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
1000 RUSH DR SALIDA, CO 81201-9627 US
Tel: 574-274-6598 Fax: --
Tel: 574-274-6598 Fax: --
Contact information for business:
PO BOX 531 PONCHA SPRINGS, CO 81242-0531 US
Tel: 574-274-6598 Fax: --
Tel: 574-274-6598 Fax: --
Registration Information:
NPI: 1427595842
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist Athletic Trainer | IN | 36003148A |
| Y | 2255A2300X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Specialist/Technologist | CO | AT.0002319 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
