Healthcare Provider Details

I. General information

NPI: 1134480403
Provider Name (Legal Business Name): CHAELI RAI AYERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N MEDCALF LN
MONTESANO WA
98563-1318
US

IV. Provider business mailing address

800 N MEDCALF LN
MONTESANO WA
98563-1318
US

V. Phone/Fax

Practice location:
  • Phone: 360-249-2363
  • Fax:
Mailing address:
  • Phone: 360-249-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP1 60067260
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: