| Doctor Name: | JESSICA AVERY |
| NPI Number: | 1255654547 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | DPT |
| License Number: | PT32353 |
| Business Practice Address: | 1695 Via Amigos San Lorenzo, CA - 945802009 |
| Business Phone Number: | 5109099266 |
| Business Fax Number: | |
| Mailing Address: | 1695 Via Amigos, SAN LORENZO |
| State: | CA |
| Postal Code: | 945802009 |
| Phone Number: | 5109099266 |
| Fax Number: | |
| NPI Enumeration Date: | 03/01/2010 |
| NPI Last Update Date: | 11/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | PT32353 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |