Provider Demographics
NPI:1023386737
Name:POLAND, ASHLEY BROOKE (PT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:BROOKE
Last Name:POLAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:436 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901-3009
Mailing Address - Country:US
Mailing Address - Phone:304-465-3654
Mailing Address - Fax:304-465-8551
Practice Address - Street 1:436 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-3009
Practice Address - Country:US
Practice Address - Phone:304-465-3654
Practice Address - Fax:304-465-8551
Is Sole Proprietor?:No
Enumeration Date:2011-12-08
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV0026212225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist