Provider Demographics
NPI:1730220807
Name:AYRES, SHIRLEY S (PT)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:S
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 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:403 W. STANLEY ST
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252
Practice Address - Country:US
Practice Address - Phone:360-691-4835
Practice Address - Fax:360-691-2545
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002081225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0279852OtherL & I
WA0280339OtherL&I
WA8339848Medicaid
WA0279828OtherL & I
WA0279854OtherL & I
WAAB15748Medicare ID - Type Unspecified
WAG8900814Medicare PIN
WAG8901124Medicare PIN
WA0279852OtherL & I
WA0279828OtherL & I