Provider Demographics
NPI:1083999023
Name:WALDUN, ASHLEY ELIZABETH (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:WALDUN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 GOLDSBOROUGH DR
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-4003
Mailing Address - Country:US
Mailing Address - Phone:410-647-6473
Mailing Address - Fax:
Practice Address - Street 1:166 GOLDSBOROUGH DR
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-4003
Practice Address - Country:US
Practice Address - Phone:410-647-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3704225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant