Provider Demographics
NPI:1235505066
Name:AVILA, ROBERT CARLOS JR (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CARLOS
Last Name:AVILA
Suffix:JR
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 PARADOR BND
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-9058
Mailing Address - Country:US
Mailing Address - Phone:770-331-9925
Mailing Address - Fax:
Practice Address - Street 1:2355 DUNCANVILLE RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75211-6532
Practice Address - Country:US
Practice Address - Phone:770-331-9925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT91022255A2300X
GAAT0027482255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer