Provider Demographics
NPI:1720359979
Name:DAVIDSON, ASHLEY JANIECE (PTA)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JANIECE
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 W 22ND ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3605
Mailing Address - Country:US
Mailing Address - Phone:850-769-9142
Mailing Address - Fax:850-736-6148
Practice Address - Street 1:1937 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4510
Practice Address - Country:US
Practice Address - Phone:850-769-9142
Practice Address - Fax:850-769-9148
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22103225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant