Provider Demographics
NPI:1750450185
Name:AYOUB, EDWARD MARCUS (DPT)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:MARCUS
Last Name:AYOUB
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:MR
Other - First Name:EDWARD
Other - Middle Name:MARCUS
Other - Last Name:AYOUB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:2433 LA COSTA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-7320
Mailing Address - Country:US
Mailing Address - Phone:858-692-4112
Mailing Address - Fax:
Practice Address - Street 1:2210 MONTGOMERY AVE APT 5
Practice Address - Street 2:
Practice Address - City:CARDIFF BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:92007-1924
Practice Address - Country:US
Practice Address - Phone:858-692-4112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT28800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist