Provider Demographics
NPI:1467175992
Name:AYRES, STEPHEN MARK (PT DPT)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:MARK
Last Name:AYRES
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26700 TOWNE CENTRE DR STE 120
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-2843
Mailing Address - Country:US
Mailing Address - Phone:949-597-2103
Mailing Address - Fax:949-597-2061
Practice Address - Street 1:26700 TOWNE CENTRE DR STE 120
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2843
Practice Address - Country:US
Practice Address - Phone:949-597-2103
Practice Address - Fax:949-597-2061
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA302477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist