Provider Demographics
NPI:1245534783
Name:PELT, ASHLEY (DPT)
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:
Last Name:PELT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4565 RED OAK TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446-2430
Mailing Address - Country:US
Mailing Address - Phone:850-209-2215
Mailing Address - Fax:
Practice Address - Street 1:4565 RED OAK TRCE
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446-2430
Practice Address - Country:US
Practice Address - Phone:850-209-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-25
Last Update Date:2010-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist