Provider Demographics
NPI:1114320744
Name:AYSON, ANGELA MARIE GEREZ-MARTINEZ (DPT)
Entity type:Individual
Prefix:
First Name:ANGELA MARIE
Middle Name:GEREZ-MARTINEZ
Last Name:AYSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3908 10TH ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3522
Mailing Address - Country:US
Mailing Address - Phone:951-274-7744
Mailing Address - Fax:951-274-7754
Practice Address - Street 1:972 MESA VIEW ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91784-8000
Practice Address - Country:US
Practice Address - Phone:909-973-3856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41356225100000X
CAPT41356225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist