Individual
JASON J AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1108 WEST KILPATRIK, CLEBURNE, TX 76031
(409) 284-1554
Mailing address
801 S WALNUT ST, CLEBURNE, TX 76033-6205
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2034577
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2034577
THERAPY
TX
Enumeration date
06/26/2007
Last updated
07/08/2007
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