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General NPI Number Information
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NPI Number | 1720842008
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Entity Type | Individual
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Provider Name | DEVIN AVERY
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Gender | Male
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 2331 GRAVEL DR
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City | FORT WORTH
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State | TX
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Zip | 76118-6951
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Country | US
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Telephone | 817-921-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 13365 HEDGEBROOK PL
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City | ALEDO
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State | TX
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Zip | 76008-2123
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Country | US
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Telephone | 817-933-9305
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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 | 247200000X
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Taxonomy Name | Other Technician
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2105301
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License Number State | TX
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