Provider Demographics
NPI:1568126928
Name:AYERS, LAUREN S (PTA)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:S
Last Name:AYERS
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 1:1440 DECATUR ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5213
Mailing Address - Country:US
Mailing Address - Phone:717-870-5288
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD BLDG 2ND
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-2991
Practice Address - Country:US
Practice Address - Phone:877-772-6505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA4610225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA4610OtherMD BOARD OF PHYSICAL THERAPY