Provider Demographics
NPI:1104206770
Name:SANIEL-ASENJO, AYN MARIE (PT)
Entity Type:Individual
Prefix:
First Name:AYN MARIE
Middle Name:
Last Name:SANIEL-ASENJO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4033 HERITAGE LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-5098
Mailing Address - Country:US
Mailing Address - Phone:417-499-9542
Mailing Address - Fax:
Practice Address - Street 1:4033 HERITAGE LN
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-5098
Practice Address - Country:US
Practice Address - Phone:417-499-9542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT331162251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics