Healthcare Provider Details

I. General information

NPI: 1295203479
Provider Name (Legal Business Name): SHARON ASHLEY MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2018
Last Update Date: 11/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 MAYBANK HWY
JOHNS ISLAND SC
29455-4825
US

IV. Provider business mailing address

669 FORT SUMTER DR
CHARLESTON SC
29412-4333
US

V. Phone/Fax

Practice location:
  • Phone: 843-559-5888
  • Fax:
Mailing address:
  • Phone: 413-348-3175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number5209
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier5209
Identifier TypeMEDICAID
Identifier StateSC
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: