Individual
MRS. SUSAN ELAINE GANDY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
4005 LAMAR AVENUE, PARIS, TX 75462
(903) 785-3861
(903) 739-8768
Mailing address
4005 LAMAR AVENUE, PARIS, TX 75462
(903) 785-3861
(903) 739-8768
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1032613
TX
2251H1200X
Hand Physical Therapist
1032613
TX
2251S0007X
Sports Physical Therapist
1032613
TX
2251X0800X
Orthopedic Physical Therapist
Primary
1032613
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058541601
—
TX
05
—
100672030B
—
OK
01
—
120492
SUPERIOR PROVIDER NUMBER
—
01
—
7032430
AETNA PROVIDER NUMBER
—
01
—
80811T
BCBS PROVIDER NUMBER
TX
Enumeration date
06/08/2006
Last updated
07/18/2015
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