Individual
MR. KEVIN M AVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT, ATC
Contact information
Practice address
1180 SATELLITE BLVD NW, SUITE 100, SUWANEE, GA 30024-4636
(404) 367-2080
(770) 495-3493
Mailing address
1180 SATELLITE BLVD NW, SUITE 100, SUWANEE, GA 30024-4636
(404) 367-2080
(770) 495-3493
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
20091
MA
225100000X
Physical Therapist
Primary
PT010906
GA
2255A2300X
Athletic Trainer
1356
MA
Other
Enumeration date
04/03/2007
Last updated
11/22/2013
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