Healthcare Provider Details

I. General information

NPI: 1386058287
Provider Name (Legal Business Name): ASHTON MULLETT-MOON DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 CANTON RD NW
CARROLLTON OH
44615-8400
US

IV. Provider business mailing address

1001 CANTON RD NW
CARROLLTON OH
44615-8400
US

V. Phone/Fax

Practice location:
  • Phone: 330-627-8873
  • Fax:
Mailing address:
  • Phone: 330-627-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014799
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: