Provider Demographics
NPI:1205269776
Name:CULVER, AVERY ROY (PT)
Entity type:Individual
Prefix:DR
First Name:AVERY
Middle Name:ROY
Last Name:CULVER
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 1:624 ROSS RD
Mailing Address - Street 2:
Mailing Address - City:DEATSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36022-5708
Mailing Address - Country:US
Mailing Address - Phone:251-229-3294
Mailing Address - Fax:
Practice Address - Street 1:1824 GLYNWOOD DR
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066-5583
Practice Address - Country:US
Practice Address - Phone:334-361-4711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL44992225100000X
ALPTH6269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist