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General NPI Number Information
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NPI Number | 1386864791
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Entity Type | Individual
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Provider Name | SAMANTHA DAWN ASHFORD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 741 S DRIVE
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City | MOUNT IDA
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State | AR
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Zip | 71957
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Country | US
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Telephone | 870-867-2584
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2511
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City | WALDRON
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State | AR
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Zip | 72958-2511
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Country | US
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Telephone | 479-637-5368
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 2084
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License Number State | AR
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