Healthcare Provider Details

I. General information

NPI: 1306294798
Provider Name (Legal Business Name): ASHLEY CANFIELD DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22556 AMENDOLA TER STE 150
ASHBURN VA
20148-2413
US

IV. Provider business mailing address

1100 CIRCLE 75 PKWY SE STE 1400
ATLANTA GA
30339-3067
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-7989
  • Fax: 703-717-7990
Mailing address:
  • Phone: 678-981-3543
  • Fax: 678-567-6737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305210237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: