Healthcare Provider Details

I. General information

NPI: 1972186765
Provider Name (Legal Business Name): LINDSEY ELIZABETH AYALA DPT, PT, LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 2ND AVE NE
ST PETERSBURG FL
33701-3405
US

IV. Provider business mailing address

5915 BRADEN RUN
BRADENTON FL
34202-9403
US

V. Phone/Fax

Practice location:
  • Phone: 727-502-1291
  • Fax:
Mailing address:
  • Phone: 813-766-9683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number30078
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: