Provider Demographics
NPI:1861806788
Name:AVALOS, LAYRA (MSPT, MSHCM)
Entity type:Individual
Prefix:
First Name:LAYRA
Middle Name:
Last Name:AVALOS
Suffix:
Gender:F
Credentials:MSPT, MSHCM
Other - Prefix:
Other - First Name:LAYRA
Other - Middle Name:
Other - Last Name:BONETA-AVALOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT, MSHCM
Mailing Address - Street 1:125 S AVONDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-5212
Mailing Address - Country:US
Mailing Address - Phone:480-442-8059
Mailing Address - Fax:623-907-8600
Practice Address - Street 1:125 S AVONDALE BLVD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323-5212
Practice Address - Country:US
Practice Address - Phone:480-442-8059
Practice Address - Fax:623-907-8600
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10853225100000X, 2251G0304X, 2251N0400X, 2251P0200X, 2251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ908446OtherARIZONA HEALTH CARE COST CONTAINMENT SYSTEM