Provider Demographics
NPI:1700602505
Name:AYALA, AMANDA OLIVIA
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:OLIVIA
Last Name:AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 OLD HICKORY BLVD UNIT 142
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-5395
Mailing Address - Country:US
Mailing Address - Phone:862-202-1780
Mailing Address - Fax:
Practice Address - Street 1:6117 CENTENNIAL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-1359
Practice Address - Country:US
Practice Address - Phone:629-206-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic