Provider Demographics
NPI:1275071565
Name:MITCHELL-AYRES, NIKKI (PTA)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:
Last Name:MITCHELL-AYRES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 CENTRE VIEW BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-5435
Mailing Address - Country:US
Mailing Address - Phone:859-301-2168
Mailing Address - Fax:859-301-2458
Practice Address - Street 1:741 CENTRE VIEW BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5435
Practice Address - Country:US
Practice Address - Phone:859-301-2168
Practice Address - Fax:859-301-2458
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA00370225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant