Provider Demographics
NPI:1407478845
Name:DANIELSEN, ASHLEY KRISTIN
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KRISTIN
Last Name:DANIELSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20347 TIMBERLAKE RD STE B
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-7352
Mailing Address - Country:US
Mailing Address - Phone:540-296-3203
Mailing Address - Fax:434-409-1695
Practice Address - Street 1:12281 MONETA RD
Practice Address - Street 2:
Practice Address - City:MONETA
Practice Address - State:VA
Practice Address - Zip Code:24121-6403
Practice Address - Country:US
Practice Address - Phone:540-296-3203
Practice Address - Fax:434-509-1695
Is Sole Proprietor?:No
Enumeration Date:2020-05-07
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist