Provider Demographics
NPI:1558480970
Name:AYRE, BRENDA (PT)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:AYRE
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04098-0310
Mailing Address - Country:US
Mailing Address - Phone:207-854-1239
Mailing Address - Fax:207-854-1230
Practice Address - Street 1:1 WESTBROOK CMN
Practice Address - Street 2:SUITE 2
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-2804
Practice Address - Country:US
Practice Address - Phone:207-854-1239
Practice Address - Fax:207-854-1230
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT1436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5305799OtherCIGNA
ME314620099Medicaid
ME082 040909OtherANTHEM BCBS
MEMNT112OtherMACHIGONNE
MEMM8682Medicare PIN