Individual
COURTNEY NICHOLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
13 NORTHTOWN DR STE 110, JACKSON, MS 39211-3047
(601) 206-9195
Mailing address
563 CLUBHOUSE DR, PEARL, MS 39208-9506
(662) 372-3000
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
6921
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6921
PRIVATE INSURANCE
MS
Enumeration date
03/22/2021
Last updated
03/22/2021
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