Provider Demographics
NPI:1710183033
Name:AYALA, ALLAN JESS (RPT)
Entity Type:Individual
Prefix:
First Name:ALLAN
Middle Name:JESS
Last Name:AYALA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1732
Mailing Address - Country:US
Mailing Address - Phone:863-314-9208
Mailing Address - Fax:
Practice Address - Street 1:3600 S HIGHLANDS AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5416
Practice Address - Country:US
Practice Address - Phone:863-385-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT13127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist