Provider Demographics
NPI:1114250719
Name:AYALA, MOLLIE YVONNE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:YVONNE
Last Name:AYALA
Suffix:
Gender:F
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 1:1124 E DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-3133
Mailing Address - Country:US
Mailing Address - Phone:210-634-8377
Mailing Address - Fax:
Practice Address - Street 1:1514 CESAR CHAVEZ
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-9648
Practice Address - Country:US
Practice Address - Phone:210-364-8377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT44352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer