MEDICARE: ASHLEY NICHELLE CANADAY 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
2	225700000X	Massage Therapist	MA51369	FL
3	225100000X	Physical Therapist	PT32647	FL

General Provider Information

NPI Number	:	1316212061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY NICHELLE CANADAY PT, DPT

Provider Business Mailing Address
First Line	:	755 S 5TH ST
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063-2685
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 S 5TH ST
Second Line	:
City	:	MACCLENNY
State	:	FL
Zip	:	32063-2685
Country	:	US
Telephone Number	:	904-259-4873
Fax Number	:

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

Provider Enumeration Date	:	03/14/2012
Last Update Date	:	07/13/2024

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