MEDICARE: ASHLEY EYE 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		GA

General Provider Information

NPI Number	:	1255963591
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY EYE PT, DPT

Provider Business Mailing Address
First Line	:	6397 LEE HWY STE 300
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37421-4915
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:	423-238-3473

Provider Business Practice Location Address
First Line	:	8492 HIRAM ACWORTH HWY STE 211
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30157-4710
Country	:	US
Telephone Number	:	770-917-9603
Fax Number	:	770-917-9605

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	02/05/2020

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Directions to “ ASHLEY EYE PT, DPT” Practice Location

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