Healthcare Provider Details

I. General information

NPI: 1194176925
Provider Name (Legal Business Name): ASHLEY PREWETT P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

536 OLD HOWELL RD
GREENVILLE SC
29615-1969
US

IV. Provider business mailing address

2630 BECHERS BRK
LAWRENCEVILLE GA
30043-6346
US

V. Phone/Fax

Practice location:
  • Phone: 877-508-3237
  • Fax:
Mailing address:
  • Phone: 478-737-5136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT012319
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: