Provider Demographics
NPI:1467852905
Name:EZELL, ASHLEY C (DPT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:C
Last Name:EZELL
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 1:22292 US HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35613-2604
Mailing Address - Country:US
Mailing Address - Phone:256-233-2313
Mailing Address - Fax:256-233-8577
Practice Address - Street 1:22292 US HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35613-2604
Practice Address - Country:US
Practice Address - Phone:256-233-2313
Practice Address - Fax:256-233-8577
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH6443225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist