Provider Demographics
NPI:1902985971
Name:AVOLIO, JOSEPH (PT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:AVOLIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 RESOURCE PKWY
Mailing Address - Street 2:BUILDING 8 UNIT B
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-8364
Mailing Address - Country:US
Mailing Address - Phone:770-307-2199
Mailing Address - Fax:770-307-2199
Practice Address - Street 1:367 RESOURCE PKWY
Practice Address - Street 2:BUILDING 8 UNIT B
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-8364
Practice Address - Country:US
Practice Address - Phone:770-307-2199
Practice Address - Fax:770-307-2199
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT005140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00934832AMedicaid
GAPT005140OtherPHYSICAL THERAPY LICENSE
GA00934832AMedicaid