Provider Demographics
NPI:1174194252
Name:AVION PT LLC
Entity type:Organization
Organization Name:AVION PT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:DETARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-831-8691
Mailing Address - Street 1:721 N FEDERAL HWY STE 4
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3152
Mailing Address - Country:US
Mailing Address - Phone:954-902-5150
Mailing Address - Fax:
Practice Address - Street 1:721 N FEDERAL HWY STE 4
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3152
Practice Address - Country:US
Practice Address - Phone:954-902-5150
Practice Address - Fax:754-900-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-08
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Single Specialty