Provider Demographics
NPI:1780166140
Name:ASHTON, DONOVAN JORDAN (PT, DPT, LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:DONOVAN
Middle Name:JORDAN
Last Name:ASHTON
Suffix:
Gender:M
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17B COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-2094
Mailing Address - Country:US
Mailing Address - Phone:570-877-7209
Mailing Address - Fax:
Practice Address - Street 1:168 BOSTON POST RD STE 9
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2163
Practice Address - Country:US
Practice Address - Phone:203-421-2435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-02
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT17742255A2300X
CT14020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer