Provider Demographics
NPI:1477712065
Name:AYRES, JOHN WESLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WESLEY
Last Name:AYRES
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 E CENTRAL AVE
Mailing Address - Street 2:PO BOX 10
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-8897
Mailing Address - Country:US
Mailing Address - Phone:316-733-1331
Mailing Address - Fax:316-733-4916
Practice Address - Street 1:308 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:KS
Practice Address - Zip Code:67002-8897
Practice Address - Country:US
Practice Address - Phone:316-733-1331
Practice Address - Fax:316-733-4916
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-03837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200568340AMedicaid
KS200568340AMedicaid