Provider Demographics
NPI:1619143385
Name:AVILA PHYSICAL THERAPY FOR WOMENS HEALTH
Entity Type:Organization
Organization Name:AVILA PHYSICAL THERAPY FOR WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ONWER/PT
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-215-5225
Mailing Address - Street 1:308 GREENVILLE BLVD SE
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5758
Mailing Address - Country:US
Mailing Address - Phone:252-215-5225
Mailing Address - Fax:252-215-5226
Practice Address - Street 1:308 GREENVILLE BLVD SE
Practice Address - Street 2:SUITE B-3
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5758
Practice Address - Country:US
Practice Address - Phone:252-215-5225
Practice Address - Fax:252-215-5226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID