Individual
DAVA MAE MCNUTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1114 GEORGIANA ST, PORT ANGELES, WA 98362-4212
(360) 452-6216
(360) 452-8965
Mailing address
16083 SW UPPER BOONES FERRY RD, STE 300, TIGARD, OR 97224-7736
(800) 219-8835
(503) 639-9699
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT00002223
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136642525
—
WA
05
—
7022296
—
WA
01
—
P00937210
RR MEDICARE
OR
Enumeration date
11/23/2005
Last updated
11/09/2012
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