Provider Demographics
NPI:1275010910
Name:ASHLEY, JAKE
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-6426
Mailing Address - Country:US
Mailing Address - Phone:903-882-6400
Mailing Address - Fax:903-882-6404
Practice Address - Street 1:616 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771
Practice Address - Country:US
Practice Address - Phone:903-882-6400
Practice Address - Fax:903-882-6404
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant