Provider Demographics
NPI:1114240686
Name:AVERY, DOUGLAS L (PT)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:L
Last Name:AVERY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 982
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:81423-0982
Mailing Address - Country:US
Mailing Address - Phone:970-327-0161
Mailing Address - Fax:970-240-8823
Practice Address - Street 1:1607 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:CO
Practice Address - Zip Code:81423
Practice Address - Country:US
Practice Address - Phone:970-327-0161
Practice Address - Fax:970-240-8823
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2010-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO7498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist