Provider Demographics
NPI:1538624101
Name:SCHULLER, AVERY
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:SCHULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 LAMAR AVE
Mailing Address - Street 2:STE 105
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460
Mailing Address - Country:US
Mailing Address - Phone:903-785-3861
Mailing Address - Fax:903-784-6020
Practice Address - Street 1:3270 LAMAR AVE
Practice Address - Street 2:STE 105
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460
Practice Address - Country:US
Practice Address - Phone:903-785-3861
Practice Address - Fax:903-784-6020
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1314749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist