Provider Demographics
NPI:1265007801
Name:PORTER, ASHLEY (DPT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3760 SIXES RD STE 130
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-8196
Mailing Address - Country:US
Mailing Address - Phone:470-863-6738
Mailing Address - Fax:
Practice Address - Street 1:3760 SIXES RD STE 130
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-8196
Practice Address - Country:US
Practice Address - Phone:470-863-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT015265225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPT015265OtherGEORGIA STATE BOARD OF PHYSICAL THERAPY