Provider Demographics
NPI:1447291075
Name:AYRES, SAMUEL JEFFERY (PT)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:JEFFERY
Last Name:AYRES
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4010 DUPONT CIRCLE
Mailing Address - Street 2:SUITE L14
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4825
Mailing Address - Country:US
Mailing Address - Phone:502-899-1911
Mailing Address - Fax:502-899-1981
Practice Address - Street 1:4010 DUPONT CIRCLE
Practice Address - Street 2:SUITE L-14
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4825
Practice Address - Country:US
Practice Address - Phone:502-899-1911
Practice Address - Fax:502-899-1981
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9962251X0800X
KY000996225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY650019854OtherRAILROAD MEDICARE
5027401Medicare PIN