Provider Demographics
NPI:1962906164
Name:AYER, PHYLLIS LESLIE (PT, CST-C, MA)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:LESLIE
Last Name:AYER
Suffix:
Gender:F
Credentials:PT, CST-C, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W FIR ST STE A
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3201
Mailing Address - Country:US
Mailing Address - Phone:360-683-0632
Mailing Address - Fax:360-681-5483
Practice Address - Street 1:500 W FIR ST STE A
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3201
Practice Address - Country:US
Practice Address - Phone:360-683-0632
Practice Address - Fax:360-681-5483
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist