Provider Demographics
NPI:1376020446
Name:ADAMS, ASHLEIGH DALENE (ATC)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:DALENE
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2065
Mailing Address - Country:US
Mailing Address - Phone:254-547-4111
Mailing Address - Fax:254-547-3338
Practice Address - Street 1:525 S 25TH ST
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2065
Practice Address - Country:US
Practice Address - Phone:254-547-4111
Practice Address - Fax:254-547-3338
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT40302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty