Provider Demographics
NPI:1255633400
Name:AYALA, ANGELA NOELLE (PT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:NOELLE
Last Name:AYALA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:NOELLE
Other - Last Name:STUTZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:51 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:ME
Mailing Address - Zip Code:04930-1326
Mailing Address - Country:US
Mailing Address - Phone:207-924-0077
Mailing Address - Fax:
Practice Address - Street 1:51 HIGH ST
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:ME
Practice Address - Zip Code:04930-1326
Practice Address - Country:US
Practice Address - Phone:207-924-0077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-21
Last Update Date:2010-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT2233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist