Provider Demographics
NPI:1558722058
Name:CULBRETH, ASIA ARIEL
Entity Type:Individual
Prefix:MRS
First Name:ASIA
Middle Name:ARIEL
Last Name:CULBRETH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ASIA
Other - Middle Name:ARIEL
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8961 DANIELS CENTER DR STE 401
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0314
Mailing Address - Country:US
Mailing Address - Phone:727-871-5345
Mailing Address - Fax:
Practice Address - Street 1:9445 IVY BROOK RUN APT 1110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-7767
Practice Address - Country:US
Practice Address - Phone:727-871-5345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-10
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist