Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT011075 | GA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT011075 | GA |
NPI | 1033541560 |
---|---|
Provider Name | Matthew Payom Ayers |
First Address | Chattanooga, TN 37421-2564 |
Second Address | Woodstock, GA 30189 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2013 |
Last Update Date | 27/06/2018 |