Provider Demographics
NPI:1528381092
Name:DOUGLAS L AVERY PT PROFESSIONAL LLC
Entity Type:Organization
Organization Name:DOUGLAS L AVERY PT PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:970-327-0161
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-11
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO7498225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty