=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982575049
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AVERY ELLIS-BYERLY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2025
-----------------------------------------------------
Last Update Date | 09/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4347 W NORTHWEST HWY STE 180
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75220-3863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-654-0947
-----------------------------------------------------
Fax | 214-654-0956
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4040 VALLEY VIEW LN UNIT 407
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75244-1232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1407296
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------