Provider Demographics
NPI:1174825905
Name:TRAHAN, ASHLEY ALAINE (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:ALAINE
Last Name:TRAHAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 LYNN DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-4200
Mailing Address - Country:US
Mailing Address - Phone:504-315-8232
Mailing Address - Fax:
Practice Address - Street 1:86 LYNN DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-4200
Practice Address - Country:US
Practice Address - Phone:850-267-9010
Practice Address - Fax:850-267-0677
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07967225100000X
FLPT27382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGG466ZOtherMEDICARE
FLGG466ZOtherMEDICARE