Provider Demographics
NPI:1063877967
Name:IMGRUND-FLORA, ASHLEY (MS, LAT, ATC, PA)
Entity type:Individual
Prefix:MS
First Name:ASHLEY
Middle Name:
Last Name:IMGRUND-FLORA
Suffix:
Gender:F
Credentials:MS, LAT, ATC, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-634-2676
Mailing Address - Fax:252-637-4479
Practice Address - Street 1:738 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:252-634-2676
Practice Address - Fax:252-637-4479
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-19322255A2300X
WV390200000X
NC0010-06896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCTYPE 22OtherRESPIRATORY, REHABILITATIVE, & RESTORATIVE SERVICE PROVIDERS