Provider Demographics
NPI:1578563557
Name:ASHTON, TRICIA (PT)
Entity Type:Individual
Prefix:
First Name:TRICIA
Middle Name:
Last Name:ASHTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 CHEROKEE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2320
Mailing Address - Country:US
Mailing Address - Phone:703-916-0202
Mailing Address - Fax:703-916-0200
Practice Address - Street 1:5510 CHEROKEE AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2320
Practice Address - Country:US
Practice Address - Phone:703-916-0202
Practice Address - Fax:703-916-0200
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305003107174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA40960OtherMAMSI/OPTIMUMCHOICE/MDIPA
VA028536OtherANTHEM
VA505232Medicare ID - Type Unspecified