Provider Demographics
NPI:1881113371
Name:RINGQUIST, AVERY M (PT, DPT)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:M
Last Name:RINGQUIST
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3208
Mailing Address - Country:US
Mailing Address - Phone:860-878-8914
Mailing Address - Fax:
Practice Address - Street 1:1510 W BRANCH ST
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1817
Practice Address - Country:US
Practice Address - Phone:805-489-7912
Practice Address - Fax:805-489-9697
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA293621208100000X
CAPT293621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation