Active NPI
Justin Avila, PT, DPT, CSCS
- Physical Therapist
- Frederick, MD
National Provider Identifier
1093358137
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 12418
- Practice address
- 1341 Hughes Ford Rd Ste 104
Frederick, MD 21701-3134 - Phone
- (301) 798-4838
- NPI assigned
- Oct 22, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 12418 | TN | Primary |
Addresses
Primary practice location
1341 Hughes Ford Rd Ste 104
Frederick, MD 21701-3134
Mailing address
2712 Call Hill Rd
Nashville, TN 37211-6870
Phone (619) 985-9811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27730 | MD | MD | Pharmacist |
| 12418 | TN | MD | Obstetrics & Gynecology Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571702400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1571702400000",
"number": "1093358137",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2712 CALL HILL RD",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372116870",
"telephone_number": "619-985-9811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1341 HUGHES FORD RD STE 104",
"city": "FREDERICK",
"state": "MD",
"postal_code": "217013134",
"telephone_number": "301-798-4838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVILA",
"first_name": "JUSTIN",
"credential": "PT, DPT, CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-10-22",
"last_updated": "2019-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TN",
"license": "12418",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Frederick, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.