Healthcare Provider Details

I. General information

NPI: 1467965699
Provider Name (Legal Business Name): ASHLEY BRASHEAR PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2017
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

193 GLADES RD
BEREA KY
40403-2261
US

IV. Provider business mailing address

193 GLADES RD
BEREA KY
40403-2261
US

V. Phone/Fax

Practice location:
  • Phone: 859-986-1055
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number007256
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: