Basic Information
| Provider Information | |||||||||
| NPI: | 1801377551 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | ASHLEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7319 N LOOP 1604 E APT 434 | ||||||||
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| City: | LIVE OAK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782335667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083095446 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6211 S NEW BRAUNFELS AVE | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782233175 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105310569 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2018 | ||||||||
| LastUpdateDate: | 08/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2139908 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.