Provider Demographics
NPI:1740490184
Name:PIERA-AVILA, LINDA MARY (PT)
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARY
Last Name:PIERA-AVILA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LINDA
Other - Middle Name:MARY
Other - Last Name:PIERA-AVILA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1424 12TH ST
Mailing Address - Street 2:APT. E
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3048
Mailing Address - Country:US
Mailing Address - Phone:310-395-4044
Mailing Address - Fax:
Practice Address - Street 1:2317 BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2915
Practice Address - Country:US
Practice Address - Phone:310-829-2225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 24096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist