Healthcare Provider Details

I. General information

NPI: 1174194252
Provider Name (Legal Business Name): AVION PT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N FEDERAL HWY STE 4
FORT LAUDERDALE FL
33304-3152
US

IV. Provider business mailing address

721 N FEDERAL HWY STE 4
FORT LAUDERDALE FL
33304-3152
US

V. Phone/Fax

Practice location:
  • Phone: 954-902-5150
  • Fax: 754-900-5044
Mailing address:
  • Phone: 954-902-5150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN MARK DETARDO
Title or Position: MEMBER
Credential:
Phone: 786-831-8691