Provider Demographics
NPI:1720043136
Name:ASHLEY, KENNETH (ATC)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:643 COUNTRY ESTATES ROAD
Mailing Address - Street 2:
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522
Mailing Address - Country:US
Mailing Address - Phone:434-352-3731
Mailing Address - Fax:
Practice Address - Street 1:35 EAGLE DR
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2859
Practice Address - Country:US
Practice Address - Phone:434-315-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01260006952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer