Healthcare Provider Details

I. General information

NPI: 1619143385
Provider Name (Legal Business Name): AVILA PHYSICAL THERAPY FOR WOMENS HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2008
Last Update Date: 05/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 GREENVILLE BLVD SE SUITE B-3
GREENVILLE NC
27858-5758
US

IV. Provider business mailing address

308 GREENVILLE BLVD SE SUITE B-3
GREENVILLE NC
27858-5758
US

V. Phone/Fax

Practice location:
  • Phone: 252-215-5225
  • Fax: 252-215-5226
Mailing address:
  • Phone: 252-215-5225
  • Fax: 252-215-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ALLYSON DAUGHERTY
Title or Position: ONWER/PT
Credential:
Phone: 252-215-5225