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General NPI Number Information
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NPI Number | 1174194252
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Entity Type | Organization
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Legal Business Name | AVION PT LLC
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Dates
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Enumeration Date | 07/08/2021
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Last Update Date | 03/02/2025
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Provider Practice Location Address
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Address Line | 721 N FEDERAL HWY STE 4
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3152
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Country | US
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Telephone | 954-902-5150
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Fax | 754-900-5044
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Provider Business Mailing Address
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Address Line | 721 N FEDERAL HWY STE 4
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3152
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Country | US
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Telephone | 954-902-5150
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | STEVEN MARK DETARDO
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Credential |
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Telephone | 786-831-8691
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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