MEDICARE: ASHLEY E MCCALL MPT, PHD

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	PT015657	GA

General Provider Information

NPI Number	:	1629626924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY E MCCALL MPT, PHD

Provider Business Mailing Address
First Line	:	4343 SHALLOWFORD RD STE 420
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5067
Country	:	US
Telephone Number	:	404-640-0164
Fax Number	:	770-706-7733

Provider Business Practice Location Address
First Line	:	4343 SHALLOWFORD RD STE 420
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-5067
Country	:	US
Telephone Number	:	404-640-0164
Fax Number	:	770-706-7733

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

Provider Enumeration Date	:	08/29/2019
Last Update Date	:	05/20/2026

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