Provider Demographics
NPI:1265711857
Name:VACCARELLA, ASHLEY KUEHNE (DPT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KUEHNE
Last Name:VACCARELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:ELAINE
Other - Last Name:KUEHNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2759 MCDONALD ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-2376
Mailing Address - Country:US
Mailing Address - Phone:985-373-4151
Mailing Address - Fax:
Practice Address - Street 1:2759 MCDONALD ST
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-2376
Practice Address - Country:US
Practice Address - Phone:985-373-4151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07617225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist