Provider Demographics
NPI:1982050654
Name:AYONAYON, RACHELLE MAE SALAS
Entity type:Individual
Prefix:
First Name:RACHELLE MAE
Middle Name:SALAS
Last Name:AYONAYON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2231 78TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-1503
Mailing Address - Country:US
Mailing Address - Phone:347-439-6770
Mailing Address - Fax:
Practice Address - Street 1:282D CEDARBRIDGE AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4265
Practice Address - Country:US
Practice Address - Phone:732-987-5122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist