Provider Demographics
NPI:1871013664
Name:AVALOS, KATHERINE LINETH (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LINETH
Last Name:AVALOS
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 NW 8TH ST APT 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2835
Mailing Address - Country:US
Mailing Address - Phone:786-426-5667
Mailing Address - Fax:
Practice Address - Street 1:16401 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6313
Practice Address - Country:US
Practice Address - Phone:305-628-6520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL44462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer