MEDICARE: ASHLEY SHIRK 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	2305207887	VA
2	225100000X	Physical Therapist	PT32160	FL

General Provider Information

NPI Number	:	1811323421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY SHIRK DPT

Provider Business Mailing Address
First Line	:	65 CROSSING LN UNIT D
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-6279
Country	:	US
Telephone Number	:	410-490-1954
Fax Number	:

Provider Business Practice Location Address
First Line	:	65 CROSSING LN UNIT D
Second Line	:
City	:	SANTA ROSA BEACH
State	:	FL
Zip	:	32459-6279
Country	:	US
Telephone Number	:	410-490-1954
Fax Number	:

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

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	12/19/2019

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