MEDICARE: ASHLEY DANIELLE JOHNSON PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA8548	AL

General Provider Information

NPI Number	:	1427711688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY DANIELLE JOHNSON PTA

Provider Business Mailing Address
First Line	:	3535 ASHLEY RD
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36108-3718
Country	:	US
Telephone Number	:	334-303-3071
Fax Number	:

Provider Business Practice Location Address
First Line	:	2853 FORBES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-261-3445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2021
Last Update Date	:	10/14/2021

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