Healthcare Provider Details

I. General information

NPI: 1881558757
Provider Name (Legal Business Name): AVERY MARLENNA BIBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 BLUE RIDGE RD STE 200
RALEIGH NC
27607-6462
US

IV. Provider business mailing address

2709 BLUE RIDGE RD STE 200
RALEIGH NC
27607-6462
US

V. Phone/Fax

Practice location:
  • Phone: 919-784-4696
  • Fax: 919-784-4697
Mailing address:
  • Phone: 919-784-4696
  • Fax: 919-784-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: