Provider Demographics
NPI:1609998236
Name:OVERBY, AVERELL S (PT DN PH)
Entity Type:Individual
Prefix:DR
First Name:AVERELL
Middle Name:S
Last Name:OVERBY
Suffix:
Gender:F
Credentials:PT DN PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W 290 GROVER CENTER
Mailing Address - Street 2:OHIO UNIVERSITY THERAPY ASSOCIATES
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2979
Mailing Address - Country:US
Mailing Address - Phone:740-593-0820
Mailing Address - Fax:
Practice Address - Street 1:W 290 GROVER CENTER
Practice Address - Street 2:OHIO UNIVERSITY
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2979
Practice Address - Country:US
Practice Address - Phone:740-593-2624
Practice Address - Fax:740-593-0293
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT001377225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000163115OtherANTHEM
OH062447Medicaid
OH366549Medicare ID - Type UnspecifiedGROUP NUMBER