MEDICARE: ASHLEY MANFORD PT, DPT

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
1	225100000X	Physical Therapist	PT39635	FL

General Provider Information

NPI Number	:	1134807365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MANFORD PT, DPT

Provider Business Mailing Address
First Line	:	27 LEE DR
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-9700
Country	:	US
Telephone Number	:	386-338-1221
Fax Number	:

Provider Business Practice Location Address
First Line	:	8845 NORTH MILITARY TRAIL
Second Line	:	SUITE 300
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33410
Country	:	US
Telephone Number	:	561-560-5999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2023
Last Update Date	:	07/07/2023

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