Provider Demographics
NPI:1992834071
Name:AVILA, NANCY JEANNE (PT)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEANNE
Last Name:AVILA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:CA
Mailing Address - Zip Code:95223-0679
Mailing Address - Country:US
Mailing Address - Phone:209-795-2674
Mailing Address - Fax:
Practice Address - Street 1:181 FAIRVIEW LN
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-4809
Practice Address - Country:US
Practice Address - Phone:209-532-6463
Practice Address - Fax:209-532-3420
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist