Provider Demographics
NPI:1740824408
Name:YOOS, ASHLEY JORDAN (PT, DPT, AIB-VR)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:JORDAN
Last Name:YOOS
Suffix:
Gender:F
Credentials:PT, DPT, AIB-VR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ATLANTIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2102
Mailing Address - Country:US
Mailing Address - Phone:228-282-4643
Mailing Address - Fax:
Practice Address - Street 1:1 ST JOHNS MED PK DR
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5300
Practice Address - Country:US
Practice Address - Phone:904-824-0869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35251225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist