Healthcare Provider Details

I. General information

NPI: 1154234367
Provider Name (Legal Business Name): AVERY DOUGLAS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 US 31W BYP STE 200
BOWLING GREEN KY
42101-2557
US

IV. Provider business mailing address

1249 US 31W BYP STE 200
BOWLING GREEN KY
42101-2557
US

V. Phone/Fax

Practice location:
  • Phone: 270-807-8275
  • Fax: 270-807-8274
Mailing address:
  • Phone: 270-807-8275
  • Fax: 270-807-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009591
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: