Healthcare Provider Details

I. General information

NPI: 1073279188
Provider Name (Legal Business Name): ANSLEY HUTTON PT, DPT, EP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2021
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST
AUGUSTA GA
30912-0004
US

IV. Provider business mailing address

414 GOLDFINCH DR
AUGUSTA GA
30907-3512
US

V. Phone/Fax

Practice location:
  • Phone: 229-292-3545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014821
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: