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General NPI Number Information
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NPI Number | 1477922706
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Entity Type | Individual
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Provider Name | ASHLEY ZAK PTA
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Gender | Female
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 09/16/2015
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Provider Practice Location Address
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Address Line | 24 TRUCK HOUSE RD
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2715
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Country | US
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Telephone | 706-248-7410
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Fax |
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Provider Business Mailing Address
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Address Line | 3312 AMOROSO CT UNIT 4
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City | FORT MEADE
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State | MD
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Zip | 20755-1469
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Country | US
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Telephone | 706-248-7410
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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 | PTA003372
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | A4334
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License Number State | MD
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