Healthcare Provider Details

I. General information

NPI: 1699442061
Provider Name (Legal Business Name): CAMERON DAVID AVERY DR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 LITITZ PIKE
LITITZ PA
17543-9414
US

IV. Provider business mailing address

3526 BEECH RUN LN
MECHANICSBURG PA
17050-2206
US

V. Phone/Fax

Practice location:
  • Phone: 717-569-2657
  • Fax:
Mailing address:
  • Phone: 717-525-4851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT029522
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: