Healthcare Provider Details

I. General information

NPI: 1104783596
Provider Name (Legal Business Name): ASHLEY HURST MYERS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12357 HAYNES ST
CLINTON LA
70722-3717
US

IV. Provider business mailing address

6839 ANDREWS LN
CLINTON LA
70722-4538
US

V. Phone/Fax

Practice location:
  • Phone: 225-719-0522
  • Fax:
Mailing address:
  • Phone: 225-719-0522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberA09361
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: