Provider Demographics
NPI:1750586467
Name:AYALA, CLARINA (RPT)
Entity type:Individual
Prefix:MRS
First Name:CLARINA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-1732
Mailing Address - Country:US
Mailing Address - Phone:863-314-9208
Mailing Address - Fax:
Practice Address - Street 1:725 S PINE ST
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-3654
Practice Address - Country:US
Practice Address - Phone:863-471-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15061225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist