Healthcare Provider Details

I. General information

NPI: 1013595263
Provider Name (Legal Business Name): ROBERT L ASHFORD II LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3510 ANDERSON HWY STE 2
POWHATAN VA
23139-5846
US

IV. Provider business mailing address

3041 DARNLEY DR
RICHMOND VA
23235-2521
US

V. Phone/Fax

Practice location:
  • Phone: 804-598-2100
  • Fax:
Mailing address:
  • Phone: 912-223-9297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306605512
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: