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General NPI Number Information
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NPI Number | 1467083469
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Entity Type | Individual
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Provider Name | ASHLEY LAURENNE JETER PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 01/28/2020
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Last Update Date | 01/28/2020
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Provider Practice Location Address
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Address Line | 3018 FESTIVAL WAY UNIT 323
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City | WALDORF
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State | MD
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Zip | 20601-2958
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Country | US
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Telephone | 240-754-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 655 S WILLOW ST STE 128
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City | MANCHESTER
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State | NH
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Zip | 03103-5717
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Country | US
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Telephone |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2305212561
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070023055
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27846
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License Number State | MD
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