Healthcare Provider Details

I. General information

NPI: 1477436863
Provider Name (Legal Business Name): ASHLEY REAH SPENCER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2025
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 AMELON SQ
MADISON HEIGHTS VA
24572-5981
US

IV. Provider business mailing address

216 AMELON SQ
MADISON HEIGHTS VA
24572-5981
US

V. Phone/Fax

Practice location:
  • Phone: 434-225-4210
  • Fax: 434-225-9794
Mailing address:
  • Phone: 434-225-4210
  • Fax: 434-225-9794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605393
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: