Provider Demographics
NPI:1396295747
Name:AYALA, JAVIER JR
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:AYALA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14716 LAKE VICTOR DR
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-5857
Mailing Address - Country:US
Mailing Address - Phone:956-493-8081
Mailing Address - Fax:
Practice Address - Street 1:14716 LAKE VICTOR DR
Practice Address - Street 2:
Practice Address - City:PFLUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:78660-5857
Practice Address - Country:US
Practice Address - Phone:956-493-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1172800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist