Provider Demographics
NPI:1235731696
Name:IRVIN, ASHLEY LAUREN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:LAUREN
Last Name:IRVIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:ASHLEY
Other - Middle Name:LAUREN
Other - Last Name:BIERZONSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:8624 SHORELINE DR
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-4053
Mailing Address - Country:US
Mailing Address - Phone:404-791-0513
Mailing Address - Fax:
Practice Address - Street 1:8624 SHORELINE DR
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-4053
Practice Address - Country:US
Practice Address - Phone:404-791-0513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-11
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA003206225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant