Healthcare Provider Details

I. General information

NPI: 1073493540
Provider Name (Legal Business Name): ASHLEY FLYNN PT,DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2025
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1243 WOODROW RD STE 323
STATEN ISLAND NY
10309-1725
US

IV. Provider business mailing address

60 WILLIAM AVE
STATEN ISLAND NY
10308-3160
US

V. Phone/Fax

Practice location:
  • Phone: 718-966-0111
  • Fax: 718-966-0089
Mailing address:
  • Phone: 917-932-3142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number054771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: