Provider Demographics
NPI:1174192546
Name:DAVIS, CLAIRISSA LYNN (LMT, MMP)
Entity type:Individual
Prefix:MRS
First Name:CLAIRISSA
Middle Name:LYNN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMT, MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 W 1125 N UNIT 19
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-8890
Mailing Address - Country:US
Mailing Address - Phone:435-559-9088
Mailing Address - Fax:
Practice Address - Street 1:2202 N MAIN ST STE 103
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9772
Practice Address - Country:US
Practice Address - Phone:435-704-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10685958-4701225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist