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NPI Code Detail

MEDICARE: ASHLEY POWELL PT

MEDICARE:   ASHLEY  POWELL  PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist27150FL

General Provider Information

NPI Number : 1033464581
Entity Type Code : Individual
Provider Name (Legal Business Name) : ASHLEY POWELL PT
Provider Business Mailing Address
First Line : 3301 ENCLAVE BLVD
Second Line :
City : MULBERRY
State : FL
Zip : 33860-5537
Country : US
Telephone Number : 813-732-3470
Fax Number :
Provider Business Practice Location Address
First Line : 12400 HIGH BLUFF DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92130-3077
Country : US
Telephone Number : 888-367-4041
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2012
Last Update Date : 07/20/2012

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