Provider Demographics
NPI:1366524894
Name:DAVIS, WILLIE RAY (RMT)
Entity type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:RAY
Last Name:DAVIS
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11844 BANDERA RD
Mailing Address - Street 2:276
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4132
Mailing Address - Country:US
Mailing Address - Phone:830-612-2863
Mailing Address - Fax:830-613-2863
Practice Address - Street 1:11844 BANDERA ROAD
Practice Address - Street 2:276
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4132
Practice Address - Country:US
Practice Address - Phone:830-612-2863
Practice Address - Fax:830-612-2863
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT038556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist