Provider Demographics
NPI:1174664247
Name:JEFF AYRES PT THERAPY CENTER, INC
Entity type:Organization
Organization Name:JEFF AYRES PT THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:AYRES
Authorized Official - Suffix:
Authorized Official - Credentials:PT PHYSICAL THERAPIS
Authorized Official - Phone:502-899-1911
Mailing Address - Street 1:4010 DUPONT CIRCLE
Mailing Address - Street 2:SUITE L-14
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4825
Mailing Address - Country:US
Mailing Address - Phone:502-899-1911
Mailing Address - Fax:502-899-1981
Practice Address - Street 1:4010 DUPONT CIRCLE
Practice Address - Street 2:SUITE L-14
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4825
Practice Address - Country:US
Practice Address - Phone:502-899-1911
Practice Address - Fax:502-899-1981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2000X
KY000996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
5027401Medicare PIN