Provider Demographics
NPI:1861107674
Name:DANIELS, ASHLEY KHALILA (MAT, ATC, LAT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:KHALILA
Last Name:DANIELS
Suffix:
Gender:F
Credentials:MAT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 N MAIN ST APT 1334
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76164-9513
Mailing Address - Country:US
Mailing Address - Phone:678-690-0394
Mailing Address - Fax:
Practice Address - Street 1:1005 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-2999
Practice Address - Country:US
Practice Address - Phone:678-690-0394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer