Provider Demographics
NPI:1457525339
Name:AVILA PHYSICAL THERAPY FOR WOMEN'S HEALTH INC.
Entity Type:Organization
Organization Name:AVILA PHYSICAL THERAPY FOR WOMEN'S HEALTH INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CLT, CFM
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:2008-04-22
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7478261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC=========OtherTAX ID
NC6258110001Medicare NSC