Provider Demographics
NPI:1588608723
Name:AYRES, RICHARD JAMES (PT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:AYRES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 CORTE LADERA
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-6356
Mailing Address - Country:US
Mailing Address - Phone:760-739-9668
Mailing Address - Fax:760-739-9668
Practice Address - Street 1:1627 CORTE LADERA
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-739-9668
Practice Address - Fax:760-739-9668
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT117752251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT11775OtherPHYSICAL THERAPY LICENSE