Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 5209 | MA |
NPI | 1295203479 |
---|---|
Provider Name | Sharon Ashley |
First Address | Charleston, SC 29412-4333 |
Second Address | Johns Island, SC 29455-4825 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2018 |
Last Update Date | 06/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5209 | (05) | SC |