Healthcare Provider Details

I. General information

NPI: 1235432204
Provider Name (Legal Business Name): ASHLEY E JOSE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY E MOYERS DPT

II. Dates (important events)

Enumeration Date: 12/14/2010
Last Update Date: 09/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MEMORIAL DR
KINGWOOD WV
26537-1141
US

IV. Provider business mailing address

2 ZACKQUILL CT
MORGANTOWN WV
26508-1107
US

V. Phone/Fax

Practice location:
  • Phone: 304-329-1400
  • Fax: 304-329-1175
Mailing address:
  • Phone: 304-376-5658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 002861
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: