Provider Demographics
NPI:1144958299
Name:LARK, ASHLEY SOPHIA
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SOPHIA
Last Name:LARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10950 O'MALLEY CENTRE DR.
Mailing Address - Street 2:UNIT D
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515
Mailing Address - Country:US
Mailing Address - Phone:907-341-5240
Mailing Address - Fax:907-563-3460
Practice Address - Street 1:10950 O'MALLEY CENTRE DR.
Practice Address - Street 2:UNIT D
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515
Practice Address - Country:US
Practice Address - Phone:907-341-5240
Practice Address - Fax:907-563-3460
Is Sole Proprietor?:No
Enumeration Date:2022-08-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK195453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist