Provider Demographics
NPI:1245606904
Name:DISMAN, ASHLEY NICOLE (PT, DPT)
Entity Type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:NICOLE
Last Name:DISMAN
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 1:7581 W HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-5939
Mailing Address - Country:US
Mailing Address - Phone:850-453-9475
Mailing Address - Fax:850-453-9673
Practice Address - Street 1:7581 W HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-5939
Practice Address - Country:US
Practice Address - Phone:850-453-9475
Practice Address - Fax:850-453-9673
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30679174400000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist