Provider Demographics
NPI:1083031637
Name:AVILA, ANTONIO (PT)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:DR
Other - First Name:ANTHONY
Other - Middle Name:
Other - Last Name:AVILA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:7637 RANCHO VISTA BLVD. WEST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1726 BRAESWOOD DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4584
Practice Address - Country:US
Practice Address - Phone:361-500-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-20
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1218389225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist