Provider Demographics
NPI:1740704386
Name:AVILA, GERARDO (DPT)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:AVILA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3922 WISEMAN BLVD
Mailing Address - Street 2:BLDG V, SUITE 502
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251
Mailing Address - Country:US
Mailing Address - Phone:210-775-6655
Mailing Address - Fax:210-761-7291
Practice Address - Street 1:3922 WISEMAN BLVD
Practice Address - Street 2:BLDG V, SUITE 502
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251
Practice Address - Country:US
Practice Address - Phone:210-775-6655
Practice Address - Fax:210-761-7291
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1291407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist