Provider Demographics
NPI:1720480759
Name:AYRES, JOSEPH SCOTT
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:SCOTT
Last Name:AYRES
Suffix:
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 1:8500 LINDBERGH BLVD
Mailing Address - Street 2:APT 1710
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19153-1536
Mailing Address - Country:US
Mailing Address - Phone:267-269-0558
Mailing Address - Fax:
Practice Address - Street 1:8500 LINDBERGH BLVD
Practice Address - Street 2:APT 1710
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-1536
Practice Address - Country:US
Practice Address - Phone:267-269-0558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer