Provider Demographics
NPI:1720498033
Name:AYALA GARCIA, BRENDA DENISE (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:DENISE
Last Name:AYALA GARCIA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 W RIALTO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-4138
Mailing Address - Country:US
Mailing Address - Phone:559-999-3123
Mailing Address - Fax:
Practice Address - Street 1:1581 18TH AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-2204
Practice Address - Country:US
Practice Address - Phone:559-897-5270
Practice Address - Fax:559-837-0920
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 10292225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant