Provider Demographics
NPI:1316430812
Name:NIKI AVERY PEDIATRIC PT LLC
Entity type:Organization
Organization Name:NIKI AVERY PEDIATRIC PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NIKI
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:970-590-2893
Mailing Address - Street 1:1050 37TH ST
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-2115
Mailing Address - Country:US
Mailing Address - Phone:970-590-2893
Mailing Address - Fax:
Practice Address - Street 1:1050 37TH ST
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620
Practice Address - Country:US
Practice Address - Phone:970-590-2893
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty