Provider Demographics
NPI:1710389218
Name:AYRES, KRISTA
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:AYRES
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 1:7484 INDIAN RD
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-1513
Mailing Address - Country:US
Mailing Address - Phone:419-509-1276
Mailing Address - Fax:
Practice Address - Street 1:7484 INDIAN RD
Practice Address - Street 2:
Practice Address - City:TEMPERANCE
Practice Address - State:MI
Practice Address - Zip Code:48182-1513
Practice Address - Country:US
Practice Address - Phone:419-509-1276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-16
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH07542225200000X
MI5502002862225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH07542OtherPHYSICAL THERAPIST ASSISTANT