Provider Demographics
NPI:1457029134
Name:COURSON, ASHLEY TAYLOR (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:TAYLOR
Last Name:COURSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3811 MILLPOINT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-8933
Mailing Address - Country:US
Mailing Address - Phone:321-277-1915
Mailing Address - Fax:
Practice Address - Street 1:6817 SOUTHPOINT PKWY STE 1602
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6298
Practice Address - Country:US
Practice Address - Phone:904-945-7556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA30012225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA30012OtherFL-DOH