Basic Information
Provider Information
NPI: 1295095537
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LEJA
FirstName: ASHLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 51 SOCKANOSSET CROSSROAD
Address2:  
City: CRANSTON
State: RI
PostalCode: 028869998
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 51 SOCKANOSSET CROSS RD
Address2:  
City: CRANSTON
State: RI
PostalCode: 029205536
CountryCode: US
TelephoneNumber: 4019447574
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/21/2012
LastUpdateDate: 05/21/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208100000XPT00364-GRIY Allopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation 

No ID Information.


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