Active NPI
Ashley Michele Tankersley Faircloth, D.P.T.
- Physical Therapist
- Mandeville, LA
National Provider Identifier
1225469513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 08611
- Practice address
- 1796 W Causeway Approach
Mandeville, LA 70471-2955 - Phone
- (985) 626-1671
- Fax
- (985) 624-4984
- NPI assigned
- Dec 11, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 08611 | LA | Primary |
Addresses
Primary practice location
1796 W Causeway Approach
Mandeville, LA 70471-2955
Mailing address
318 Nottoway Dr
Pearl River, LA 70452-3804
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08611 | Other | LA | LICENSE TO PRACTICE PHYSICAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1386720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386720000000",
"number": "1225469513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "318 NOTTOWAY DR",
"city": "PEARL RIVER",
"state": "LA",
"postal_code": "704523804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1796 W CAUSEWAY APPROACH",
"city": "MANDEVILLE",
"state": "LA",
"postal_code": "704712955",
"telephone_number": "985-626-1671",
"fax_number": "985-624-4984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRCLOTH",
"first_name": "ASHLEY",
"middle_name": "MICHELE TANKERSLEY",
"name_prefix": "Dr.",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-12-11",
"last_updated": "2013-12-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "LA",
"license": "08611",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE TO PRACTICE PHYSICAL THERAPY",
"identifier": "08611",
"state": "LA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mandeville, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.