Provider Demographics
NPI:1508909490
Name:BLACKMAN, ASHLEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:BLACKMAN
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 1:5170 SCANDIA RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-5411
Mailing Address - Country:US
Mailing Address - Phone:804-737-2351
Mailing Address - Fax:
Practice Address - Street 1:13109 RIVERS BEND BLVD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8607
Practice Address - Country:US
Practice Address - Phone:804-452-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260011212255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer