Provider Demographics
NPI:1316117724
Name:AVOLIO, TANIA LEA (PT)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:LEA
Last Name:AVOLIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 JOANNE CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-8400
Mailing Address - Country:US
Mailing Address - Phone:706-254-2997
Mailing Address - Fax:706-521-5557
Practice Address - Street 1:305 JOANNE CT
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-8400
Practice Address - Country:US
Practice Address - Phone:706-254-2997
Practice Address - Fax:706-521-5557
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004742225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist