Provider Demographics
NPI:1497578447
Name:CANADY, ASHTON TAYLOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:ASHTON
Middle Name:TAYLOR
Last Name:CANADY
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 1:910 S WINTERHAWK DR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3870
Mailing Address - Country:US
Mailing Address - Phone:843-270-7197
Mailing Address - Fax:
Practice Address - Street 1:910 S WINTERHAWK DR UNIT 107
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3870
Practice Address - Country:US
Practice Address - Phone:904-217-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT42446225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist