=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295184620
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ASHLEY MAY KEESLER-YOUNG
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2016
-----------------------------------------------------
Last Update Date | 02/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 906 THOMPSON ST
-----------------------------------------------------
City | ASHLAND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23005-1128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-798-3291
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 HANOVER AVE
-----------------------------------------------------
City | SANDSTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23150-2226
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-307-4960
-----------------------------------------------------
Fax | 410-648-4878
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 2305214787
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------