Provider Demographics
NPI:1245273762
Name:GOLDSTON, ASHLEY PATE (PT)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PATE
Last Name:GOLDSTON
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 1:2709 MARSH GLEN DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29582-9316
Mailing Address - Country:US
Mailing Address - Phone:843-249-7232
Mailing Address - Fax:
Practice Address - Street 1:543 HIGHWAY 17 N
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-2903
Practice Address - Country:US
Practice Address - Phone:843-249-7232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8342225100000X
SC6168225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC720777YMedicaid
NC1B 078CROtherBCBS
NC720777YMedicaid