Provider Demographics
NPI:1811413644
Name:AYRES, CHELSEA RENEE (DPT)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:RENEE
Last Name:AYRES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:RENEE
Other - Last Name:WEEDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12831 STONE CANYON RD
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2014
Mailing Address - Country:US
Mailing Address - Phone:858-829-7435
Mailing Address - Fax:
Practice Address - Street 1:13350 CAMINO DEL SUR STE 1
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4473
Practice Address - Country:US
Practice Address - Phone:858-790-8549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2935112251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic