Healthcare Provider Details

I. General information

NPI: 1215684659
Provider Name (Legal Business Name): AYREN MAKAY PARRISH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2022
Last Update Date: 03/06/2022
Certification Date: 03/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 N SAINT JOSEPH AVE
NILES MI
49120-2207
US

IV. Provider business mailing address

1733 SYCAMORE ST
NILES MI
49120-2045
US

V. Phone/Fax

Practice location:
  • Phone: 269-683-5510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501021638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: