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General NPI Number Information
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NPI Number | 1780166140
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Entity Type | Individual
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Provider Name | DONOVAN JORDAN ASHTON PT, DPT, LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/02/2018
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 168 BOSTON POST RD STE 9
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City | MADISON
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State | CT
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Zip | 06443-2163
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Country | US
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Telephone | 203-421-2435
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Fax |
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Provider Business Mailing Address
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Address Line | 17B COMMERCE ST
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City | CLINTON
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State | CT
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Zip | 06413-2094
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Country | US
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Telephone | 570-877-7209
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1774
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License Number State | CT
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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 | 14020
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License Number State | CT
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