Provider Demographics
NPI:1225010283
Name:LINDA L AVERY & ASSOCIATES PHYSICAL THERAPY INC
Entity Type:Organization
Organization Name:LINDA L AVERY & ASSOCIATES PHYSICAL THERAPY INC
Other - Org Name:LINDA L AVERY & ASSOCIATES PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:LARSSEN
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-451-6020
Mailing Address - Street 1:3300 WEBSTER ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3117
Mailing Address - Country:US
Mailing Address - Phone:510-451-6020
Mailing Address - Fax:510-451-6043
Practice Address - Street 1:3300 WEBSTER ST
Practice Address - Street 2:SUITE 402
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3117
Practice Address - Country:US
Practice Address - Phone:510-451-6020
Practice Address - Fax:510-451-6043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT113225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R27333Medicare UPIN
ZZZ5411ZMedicare ID - Type Unspecified
650006782Medicare ID - Type UnspecifiedRAILROAD