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General NPI Number Information
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NPI Number | 1083819676
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Entity Type | Individual
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Provider Name | DARA K. AVILA P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 47 EGGERS CT
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City | SUMMIT
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State | NJ
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Zip | 07901-6700
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Country | US
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Telephone | 973-310-2919
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Fax |
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Provider Business Mailing Address
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Address Line | 530 VALLEY ST
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City | MAPLEWOOD
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State | NJ
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Zip | 07040-1384
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Country | US
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Telephone | 973-310-2919
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 022462-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA01191900
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License Number State | NJ
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