MEDICARE: DEVIN AVERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247200000X	Other Technician
2	225200000X	Physical Therapy Assistant	2105301	TX

General Provider Information

NPI Number	:	1720842008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVIN AVERY

Provider Business Mailing Address
First Line	:	13365 HEDGEBROOK PL
Second Line	:
City	:	ALEDO
State	:	TX
Zip	:	76008-2123
Country	:	US
Telephone Number	:	817-933-9305
Fax Number	:

Provider Business Practice Location Address
First Line	:	2331 GRAVEL DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76118-6951
Country	:	US
Telephone Number	:	817-921-3100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2024
Last Update Date	:	05/29/2025

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Directions to “ DEVIN AVERY ” Practice Location

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