Provider Demographics
NPI:1417141698
Name:HUMPHREY AVERY, ANTOINETTE JAMIL' (DPT)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:JAMIL'
Last Name:HUMPHREY AVERY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6360 W SAM HOUSTON PKWY N
Mailing Address - Street 2:NORTH, SUITE 200
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-5164
Mailing Address - Country:US
Mailing Address - Phone:713-280-0363
Mailing Address - Fax:713-208-3457
Practice Address - Street 1:6360 W SAM HOUSTON PKWY N
Practice Address - Street 2:NORTH, SUITE 200
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-5164
Practice Address - Country:US
Practice Address - Phone:713-280-0363
Practice Address - Fax:713-208-3457
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168930225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist