Healthcare Provider Details

I. General information

NPI: 1255633400
Provider Name (Legal Business Name): ANGELA NOELLE AYALA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANGELA NOELLE STUTZMAN PT

II. Dates (important events)

Enumeration Date: 11/21/2010
Last Update Date: 11/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 HIGH ST
DEXTER ME
04930-1326
US

IV. Provider business mailing address

51 HIGH ST
DEXTER ME
04930-1326
US

V. Phone/Fax

Practice location:
  • Phone: 207-924-0077
  • Fax:
Mailing address:
  • Phone: 207-924-0077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2233
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: