Provider Demographics
NPI:1477866515
Name:AVERY, LISA JANE (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JANE
Last Name:AVERY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SANDY FORKS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-3814
Mailing Address - Country:US
Mailing Address - Phone:919-954-3492
Mailing Address - Fax:
Practice Address - Street 1:5920 SANDY FORKS RD STE 200
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-3814
Practice Address - Country:US
Practice Address - Phone:919-954-3492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist