Individual
MRS. TANISHA SHANELLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA, LMBT
Contact information
Practice address
823 ELM ST, FAYETTEVILLE, NC 28303-4172
(910) 929-4488
Mailing address
303 BONITA CT, FAYETTEVILLE, NC 28314-1722
(910) 929-4488
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
A5872
NC
225700000X
Massage Therapist
Primary
22449
NC
Other
Enumeration date
10/11/2017
Last updated
08/06/2025
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