Provider Demographics
NPI:1457870370
Name:AYALA, AMADOR III (PT)
Entity Type:Individual
Prefix:MR
First Name:AMADOR
Middle Name:
Last Name:AYALA
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:MR
Other - First Name:TREY
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1200 OLD SKOKIE RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3036
Mailing Address - Country:US
Mailing Address - Phone:847-748-8037
Mailing Address - Fax:
Practice Address - Street 1:1200 OLD SKOKIE RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3036
Practice Address - Country:US
Practice Address - Phone:847-748-8037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.023307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist