Provider Demographics
NPI:1104993278
Name:AYRES, CHERYL A (PT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:AYRES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32717 1ST AVE S
Mailing Address - Street 2:SUITE 9
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-5758
Mailing Address - Country:US
Mailing Address - Phone:253-874-6620
Mailing Address - Fax:253-874-2542
Practice Address - Street 1:32717 1ST AVE S
Practice Address - Street 2:SUITE 9
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-5758
Practice Address - Country:US
Practice Address - Phone:253-874-6620
Practice Address - Fax:253-874-2542
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8346322Medicaid
WA09521OtherLABOR & INDUSTRIES
WA8346322Medicaid