Healthcare Provider Details

I. General information

NPI: 1316117724
Provider Name (Legal Business Name): TANIA LEA AVOLIO PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CRACKERS NECK RD
GREENSBORO GA
30642-3931
US

IV. Provider business mailing address

1050 CRACKERS NECK RD
GREENSBORO GA
30642-3931
US

V. Phone/Fax

Practice location:
  • Phone: 706-254-2997
  • Fax: 706-851-2188
Mailing address:
  • Phone: 706-254-2997
  • Fax: 706-851-2188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004742
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: