Provider Demographics
NPI:1598838682
Name:AVILA, RICARDO (DPT)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1625
Mailing Address - Country:US
Mailing Address - Phone:956-345-7717
Mailing Address - Fax:956-664-9247
Practice Address - Street 1:7717 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-1625
Practice Address - Country:US
Practice Address - Phone:956-345-7717
Practice Address - Fax:956-664-9247
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1085660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX742931568OtherTIN NUMBER