Provider Demographics
NPI:1801067079
Name:AYSON, JERICHO MANALOTO (PT)
Entity type:Individual
Prefix:MR
First Name:JERICHO
Middle Name:MANALOTO
Last Name:AYSON
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:18001 N. 79TH AVE
Mailing Address - Street 2:BLDG, 3 SUITE A3
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308
Mailing Address - Country:US
Mailing Address - Phone:623-979-5266
Mailing Address - Fax:623-776-9223
Practice Address - Street 1:18001 N. 79TH AVE
Practice Address - Street 2:BLDG. 3 SUITE A3
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308
Practice Address - Country:US
Practice Address - Phone:623-979-5266
Practice Address - Fax:623-776-9223
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM3460225100000X
COPTL.0015793225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist