Healthcare Provider Details

I. General information

NPI: 1780856419
Provider Name (Legal Business Name): ALICIA ANN ASHLEY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 AUSTIN DR
YORK SC
29745-9507
US

IV. Provider business mailing address

233 AUSTIN DR
YORK SC
29745-9507
US

V. Phone/Fax

Practice location:
  • Phone: 803-526-3351
  • Fax:
Mailing address:
  • Phone: 803-526-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1998
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: