Provider Demographics
NPI:1861221236
Name:SAMUEL, ASHLEIGH J
Entity type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:J
Last Name:SAMUEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEIGH
Other - Middle Name:J
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8745 OXFORDSHIRE AVE E FL 4349
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-4349
Mailing Address - Country:US
Mailing Address - Phone:336-303-2980
Mailing Address - Fax:
Practice Address - Street 1:8745 OXFORDSHIRE AVE E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-4349
Practice Address - Country:US
Practice Address - Phone:904-535-9972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100652225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist