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General NPI Number Information
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NPI Number | 1538280698
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Entity Type | Individual
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Provider Name | KEVIN M AVILLA PT, ATC
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 1180 SATELLITE BLVD NW SUITE 100
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City | SUWANEE
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State | GA
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Zip | 30024-4636
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Country | US
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Telephone | 404-367-2080
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Fax | 770-495-3493
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Provider Business Mailing Address
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Address Line | 1180 SATELLITE BLVD NW SUITE 100
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City | SUWANEE
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State | GA
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Zip | 30024-4636
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Country | US
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Telephone | 404-367-2080
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Fax | 770-495-3493
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1356
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License Number State | MA
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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 | 20091
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT010906
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License Number State | GA
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