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NPI Code Detail

MEDICARE: MRS. GLADYS MARIE AYALA M.T

MEDICARE: MRS. GLADYS MARIE AYALA M.T
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist

General Provider Information

NPI Number : 1386883031
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GLADYS MARIE AYALA M.T
Provider Business Mailing Address
First Line : 1530 OCONNOR AVE
Second Line :
City : LINCOLN PARK
State : MI
Zip : 48146-1743
Country : US
Telephone Number : 313-574-9219
Fax Number :
Provider Business Practice Location Address
First Line : 13330 FORT ST
Second Line :
City : SOUTHGATE
State : MI
Zip : 48195-1137
Country : US
Telephone Number : 734-309-6908
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2009
Last Update Date : 10/07/2013

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