Provider Demographics
NPI:1386883031
Name:AYALA, GLADYS MARIE (MT)
Entity type:Individual
Prefix:MRS
First Name:GLADYS
Middle Name:MARIE
Last Name:AYALA
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 OCONNOR AVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-1743
Mailing Address - Country:US
Mailing Address - Phone:313-574-9219
Mailing Address - Fax:
Practice Address - Street 1:13330 FORT ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-1137
Practice Address - Country:US
Practice Address - Phone:734-309-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2013-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist