Healthcare Provider Details

I. General information

NPI: 1700663366
Provider Name (Legal Business Name): ASHLEY KING PT/AT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2023
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5103 PEGASUS CT STE A
FREDERICK MD
21704-8315
US

IV. Provider business mailing address

1010 CAPISTRANO CT APT 206
FREDERICK MD
21703-6302
US

V. Phone/Fax

Practice location:
  • Phone: 240-415-8322
  • Fax:
Mailing address:
  • Phone: 336-944-2325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASHLEY KING
Title or Position: OWNER
Credential: PT, ATC
Phone: 336-944-2325