Basic Information
| Provider Information | |||||||||
| NPI: | 1710525621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHLEY | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | ATC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 678 HIGHWAY 4 | ||||||||
| Address2: | |||||||||
| City: | DENNIS | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388389710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6623161975 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15041 HIGHWAY 43 | ||||||||
| Address2: | |||||||||
| City: | RUSSELLVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356531973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563310070 | ||||||||
| FaxNumber: | 2563310054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2019 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2255A2300X | 1978 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Specialist/Technologist | Athletic Trainer |
No ID Information.