Provider Demographics
NPI:1760130728
Name:VEGA, ASHLEIGH NICOLE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:ASHLEIGH
Middle Name:NICOLE
Last Name:VEGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 LAMPLIGHTER DR NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8008
Mailing Address - Country:US
Mailing Address - Phone:386-503-0544
Mailing Address - Fax:
Practice Address - Street 1:8045 SPYGLASS HILL RD STE 103
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-8567
Practice Address - Country:US
Practice Address - Phone:321-757-5515
Practice Address - Fax:321-757-5514
Is Sole Proprietor?:No
Enumeration Date:2022-03-17
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38393225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist