Provider Demographics
NPI:1578883708
Name:DOUAY, AZEL ROS AVILES (PT)
Entity Type:Individual
Prefix:
First Name:AZEL ROS
Middle Name:AVILES
Last Name:DOUAY
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 1:316 ROSEHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-5509
Mailing Address - Country:US
Mailing Address - Phone:509-240-2696
Mailing Address - Fax:
Practice Address - Street 1:420 SE 17TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3306
Practice Address - Country:US
Practice Address - Phone:541-276-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6018225100000X
MI5501013954225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist