Individual
STACEY AYALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1930 HIGHLAND AVE STE A, AUGUSTA, GA 30904-7803
(706) 481-9105
(706) 481-9107
Mailing address
1930 HIGHLAND AVE STE A, AUGUSTA, GA 30904-7803
(706) 481-9105
(706) 481-9107
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002614
GA
Other
Enumeration date
02/14/2011
Last updated
02/14/2011
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