Ashley Nelson, PT, DPT
Individual provider Active NPI Physical Therapist · Tamuning, GU
NPI 1154938736 · NPPES record last updated Oct 13, 2021
Key facts
- NPI
- 1154938736
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT34070 (FL)
- Practice address
- 388 Ypao Rd
Tamuning, GU 96913-3701 - Phone
- (671) 646-8881
- Fax
- (671) 648-2548
- NPI assigned
- Sep 28, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in FL, GU
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201007002347 | FL | Practitioner - Physical Therapist in Private Practice | 5496174641 | Reassigns benefits to 2 organizations |
| I20220112001300 | GU | Practitioner - Physical Therapist in Private Practice | 5496174641 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT34070 | FL | MD | Physical Therapist |
| PT-160 | GU | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesis Health Development, Inc. | Current |
Accepting new patients | |
| Optimal Performance and Physical Therapies-Riverview, LLC | Physical Therapist | Current |
Accepting new patients |
| General Conference Corp of Sda | Current |
Accepting new patients | |
| Genesis Health Development Inc | Current |
Accepting new patients |
Locations
3599 University Blvd S
Jacksonville, FL 32216
Phone (904) 345-7600
21756 State Road 54
Ste 102
Lutz, FL 33549
Phone (813) 279-6234
11375 Big Bend Rd
Riverview, FL 33579
Phone (813) 805-8167
Interoperability endpoints
- ashley.nelson@adventistclinic.directbygreenway.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-160 | GU | |
| Physical Therapist | 225100000X | PT34070 | FL | Yes |
Addresses
Primary practice location
388 Ypao Rd
Tamuning, GU 96913-3701
Mailing address
699 Timbermill LN
Orange Park, FL 32065-2233
Phone (214) 300-5327
Other practice location 1
7749 Normandy Blvd
Jacksonville, FL 32221-7657
Phone (904) 786-5576
Other providers in Tamuning, GU
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 13, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.