Provider Demographics
NPI:1285034322
Name:AMPAH, AISHA JACASTA-JONES (DPT)
Entity Type:Individual
Prefix:DR
First Name:AISHA
Middle Name:JACASTA-JONES
Last Name:AMPAH
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 1:5112 SAILCLOTH ST
Mailing Address - Street 2:
Mailing Address - City:AUBREY
Mailing Address - State:TX
Mailing Address - Zip Code:76227-4580
Mailing Address - Country:US
Mailing Address - Phone:252-258-2136
Mailing Address - Fax:
Practice Address - Street 1:5112 SAILCLOTH ST
Practice Address - Street 2:
Practice Address - City:AUBREY
Practice Address - State:TX
Practice Address - Zip Code:76227-4580
Practice Address - Country:US
Practice Address - Phone:252-258-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-26
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 29434225100000X
LA08439R225100000X
CA42157225100000X, 261QP2000X
TX1368660225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy