Provider Demographics
NPI:1376178459
Name:ASHKANI, ASHKAN
Entity Type:Individual
Prefix:
First Name:ASHKAN
Middle Name:
Last Name:ASHKANI
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 1:298 WARWICK ST APT 23
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-1134
Mailing Address - Country:US
Mailing Address - Phone:706-300-5710
Mailing Address - Fax:
Practice Address - Street 1:BACK BAY AREA PARK CENTER
Practice Address - Street 2:26396 BAY FARM RD , UNIT #1
Practice Address - City:MILLSBRO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-947-9662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0004197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist